Procession - Stanley Clark School

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A`� CERTIFICATE OF LIABILITY INSURANCE DATE 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. If 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 endorsement(s). PRODUCER NAME, Stephen Swihart Gibson Insurance Agency, Inc. PNONNo n. (800) 814-2122 AIC Ne: (600)836-2122 130 S Main St, Ste 400 ADDRESS: sswihart@gibsonina. cam PO BOX 11177 INSURERS AFFORDING COVERAGE NAICR South Bend IN 46601-0177 INS URERA:C1ncinnati Insurance Co INSURED INSURER BAccident Fund Ina Cc Amer 10166 The Stanley Clark School, Inc. INSURER C: 3123 Miami Street INSURER D: INSURER E South Bend IN 46614-2098 INSURER F: COVERAGES CERTIFICATENUMBER:16/17 Liab REVISION NUMBER' 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. I11511 LTR TYPE OF INSURANCE A DLSURR POLICY NUMBER MM% IDYL LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR CCURRENCE $ 11000,000 E TO RENTED ES (Ea occurrence $ 500, 000 P(Any one person) $ 30,000 SIP0008277 7/1/2016 NAL$ ADV INJURY W $ 1, 000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY PRO- ❑JECT LOC AL AGGREGATE $ 31000,000 CTS-COMP/OP AGG $ 3,000,000 ee Benefits $ 11000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO. ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ X UMBRELLA LIM X OCCUR EACH OCCURRENCE $ 10,0001000 AGGREGATE $ 10,000,000 A EXCESS LIAR CLAIMS -MADE DED I IRETENTIONS $ SIP0008277 7/1/2016 7/1/2017 1 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOWPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑NIA (Mandatory In NH) If yes, describe under WCV6113731 7/1/2016 7/1/2017 PER DTH- STATUTE ER EL EACH ACCIDENT $ 500,000 E.L. DISEASE -EA EMPLOYE $ 500,000 EL DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remaras Schedule, may be attached if more space 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. AUTHORIZED REPRESENTATIVE Ins Agency/STSWIH (C)'1988-201A All rinhfo ro cn n,nd ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 orlun11