Transient Merchant License Renewal - St. Joseph County Fairgrounds

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ACI Rh® CERTIFICATE OF LIABILITY INSURANCE TE DDIYYYY DA4/(7/2016 ) 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 McCarthy Insurance Group P.O. Box 1377 802 Lincolnway West Mishawaka IN 46544 CONTACT Chris Young pHoN o E (579) 259-5622 FAX No: (674)256-7822 E-MAIL Chris@mccarthyins.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC9 INSURER A:Philadel hia Insurance Com an INSURED St Joseph County 4-H Fairgrounds, inc. 5117 South Ironwood Road South Bend IN 46614 INSURER B Accident Fund INSURERC: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2016-2017 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. INSR LTR TYPE OF INSURANCE ADOLSUBft POLICY NUMBER MMIDDYIYWY MMIDOY/YEYXI'pY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR PHPK1300734 3/19/2016 3/19/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO -RENTED PREMISES Ea occurrence $ 100,000 MED EXP(Anyone person) $ 0 PERSONAL B ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT ❑ LOC OTHER: GENERAL AGGREGATE $ 3,000,000 X PRODUCTS-COMP/OP AGG $ 3,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALLOWNED SCHEDULED HIRED TSAUTOS AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT -LEa accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) 5 PROPERTY DAMAGE Peracddma $ $ A X UMBRELLALIAB EXCESS LIAB x OCCUR CLAIMS -MADE 3?010491369 3/19/2016 3/19/2017 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ DED I X I RETENTION$ 10,000 $ B WORKERS COMPENSATION ANDEMPLOYERS LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE [NIA OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below wCV6125194 3/19/2016 3/19/2017 x PER OTH- STATUTE ER E. L. EACHACCIDENT $ Soo 000 E.L. DISEASE - EA EMPLOYE $ 500 000 E.L. DISEASE -POLICY LIMIT 1 $ 500,000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) City of South Bend is additional insured as respects general liability, according to the terms and conditions of the policy. City of South Bend 227 West Jefferson Blvd 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 Vervynckt/CHRIS ACORD 25 (2014/01) INS025OT14011 U 19BB-ZU14AGORD CORPORA LION. All rights reserved. The ACORD name and logo are registered marks of ACORD