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. k.1- CERTIFICATE OF LIABILITY INSURANCE �� TE DA9/6/2D1YYPp 9/6/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. M SUBROGATION IS WAIVED, subject to the terms and Conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endomement(s). PRODUCER NCONTACr Stephen Sxihart Gibson Insurance Agency, Inc. 130 S Main St, Ste 400 P NE , (S00)Sl4-2122 N FAX No: (800)836-2122 C ADoaess: sawihart@gibsonins. cone PO BOX 21177 INSURER AFFORDING COVERAGE NAICIF South Bend IN 46601-0177 INSURER A Cincinnati Insurance Co INSURED INsuRm a Accident Fund Ina Cc Amer 10166 The Stanley Clark School, Inc. INSURERC: 3123 Miami Street INSURER D: INSURER E: South Bend IN 46614-2098 INSURER F: COVERAGES CERTIFICATE NUMBER:16/17 Liab RFVISIONNUMRFR: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LLTR TYPEOFINSURANCE IN80 POLICY NUMBER P C EFF POLICY EXP LIMM A $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR SIPOOO8277 7/1/2016 7/2/2017 EACH OCCURRENCE $ 1,000,000 DNNA P ES (En o¢urmnw $ 500,000 MED EXP(Any one pelsm) $ 10,000 PERSONAL& ADV INJURY $ 1,000,000 OENLAGGREGATELIMITAPPIJESPER $ POLICY 0JECT LOL OTHER GENERAL AGGREGATE $ 3,000,000 PRODUCTS-COMP/OP AGO $ 3,000,BDO Employes Senses $ 1,000,000 AVrOMOSILE LIABILITY ANYAUTO AUTOS B"CHEDU5 LED NON-0WNED HIRED AUTOS AUTOS Ea COMBorJde tINED SINGLE LIMIT e $ BODILY INJURY(Perperaon) $ BODILY INJURY(Pen acoMent) $ PROTYDAMAGE PER Pea ' $ $ A $ UMBRELLA LIAR O:CESSUAB $ OCCUR CLAIMS -MADE SIPO000217 7/1/2016 7/1/2D17 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DEO I I RETENTION $ B WORKERS COMPENSATION AM EMPLOYERS LI UNILBY YIN ANY PROPRIETORIPARTNERIEXECUNVE OFFICERIMEMBER EXCLUDED? ❑NIA (Mandatary in H yea deacdbe under DESCRIPTION OF OPERATIONS blow R076113731 7/1/2016 7/1/2017 PER OTH- STATUTE ER EI.EACHACCIDENT $ SDO 000 E.L. DISEASE - EA EMP $ 500,00 E.L. DISEASE - POLICY LIMB 1 $ S00 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Addhionol Remarks Sehedub, may ba stashed If mere spew Is required) RE: Clark Run October 22, 2016 City of South Bend 227 W Jefferson Stt South Bend, IN 46601 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ins Agency/STSWIH All riahts ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 nmamn