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CERTIFICATE OF LIA131LITY INSURANCE <br />DATE(MM11mrYW11 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. TMS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER, <br />IMPORTANT: If the cetlflata holder is an ADDITIONAL INSURED, the pollcy(I ) must be endorsed If SUBROGATION IS WAIVED, subject t0 <br />the terms and conditlone of the policy, certain policies may require an endorsement. A statement on this certificate does not Confer rights to the <br />certificate holder In lieu of such endomemert(s). <br />PRODUCER CONT 0!ha <br />E:E'aBA Barns <br />NAM <br />Gibson Insurance Agency, Inc, PII NE (SD_)814-2122 I wal N0: (aoole36•alaz <br />130 S Main St, Eta 400 pDpft ;tburne@gibsonina.com <br />PO BOX 11177 INSU B AFPORDINGCOVERAOE NAICe <br />South ]9enfl IN 46601-0177 ........,�..-...,______—_ <br />South Bond Heritage Foundation, Inc, <br />803 LxrHaolnmay Neat <br />Bend <br />ncnumFrt: <br />THIS IS -to CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW WAVE BEEN ISSUED TO THE INSURED NAMIED NAMED ABOVEE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT; TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />IN <br />TYPE OF INSURANCE <br />PO Y <br />M F <br />POLICYEXP <br />OMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE Q OCCUR <br />XCTJ <br />ERP0232816 <br />3/2/2016 <br />3/2/2017 <br />EACH OCCURRENCE <br />3 1,000, 000 <br />X <br />A A E Tra <br />R M OyreJca <br />MED EXP An one 6mon <br />E SDO, O00 <br />$ 3,000 <br />X <br />COritYACtual LiabiltV <br />PERSONAL&AW INJURY <br />S 1, DOD, 000 <br />GENT AGGREGATE UNIT APPLIES PER! <br />POLICY ® JECT LOC <br />OTHER: <br />GENERAL AGGREGATE <br />S 2,0110,000 <br />PRODUCTS. COMP/OP AGO <br />$ 2,000,0001 <br />Employdeemft <br />S 11000,000 <br />A <br />AUTOMOBILE <br />LLA MI t Y <br />ANY AVTO <br />AOYYNED SCHEDULED <br />AUTOS AUTOS <br />HIRED AUTOS X NON-0NMED <br />AUTOS <br />sPP0232e16 <br />3/2/2016 <br />3/2/2017 <br />COMBINED S <br />E9 same <br />E 1,000,000 <br />X <br />X <br />BODILY INJURY (PxpersOn) <br />E <br />BODILY INJURY (PeraCcideOO <br />S <br />Po, E <br />Mediml P mma <br />S <br />E 5,000 <br />A <br />IwORKHROCOMPENRATIoN <br />B <br />X <br />UMBRELLA LIAO <br />EXCESS LIAB <br />X <br />OCCUR <br />CLAIMS -MADE <br />NIA <br />aRE0232816 <br />SWCO24123301 <br />3/2/2016 <br />2/2,2016 <br />3/2/2017 <br />3/2/2017 <br />EACH OCCURRENCE <br />E 51000,000 <br />AGGREGATE <br />$ 51000,000 <br />X RETENTION 0 <br />AND EMPLOYERS' LIAOIUTY YIN <br />ANY PROPRIETOR1PARTNER,E>ZCUnI <br />OFFFIC R/MEMBER EXCLUDED? � <br />(yy .Mdry M NR) <br />OEBCRIPTIba.,*, ERATI0N8 bB10W <br />ERH <br />E <br />E.L. EACH ACGDENT <br />S 100.000 <br />El, DISEASE -EA EMPLOYE <br />8 100 000 <br />E.L. DISEASE -POLICY LIMIT I <br />S 500 ,000 <br />DESCRIPTION OFOPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AUtlaloml Remarks Sallr4uh, may ee MnFpatl a men!spacP h 1w1u1M) <br />RE: Red Ribbon IM=ch <br />Community Canter <br />Ray and Joan Kroc <br />900 W Western Ave <br />South Bend, IN 46601 <br />SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />Ins <br />REPRESENTATIVE <br />I NO AVUKIJ name ana 1090 are registered marks of ACORD <br />MS026t7o+dOn <br />