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,.,..., MARYC-1 OP ID: KL <br />s►�oszc� CERTIFICATE OF LIABILITY INSURANCE <br />DA0110612017TE Y> <br />01/0612017 <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. THIS 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 certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions 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 endorsement(s). <br />PRODUCER <br />Oswald Companies <br />2000 Polaris Parkway <br />P. O. BOX 728 <br />Columbus OH 43216.0728 <br />James B. bswald Company House <br />CONTACT James B. Oswald Company HouNAME,se <br />PxoxE 614-796-7728 <br />Alc No •888-323-1383 AX No: <br />EMAIL <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE <br />NAIC# <br />INSURERA:Westfield Insurance Company <br />24112 <br />INSURED Mary Coyne Investments LLC <br />Coyne Investments LTD <br />1428 Hamilton Ave <br />INSURER B: <br />INSURER C: <br />Cleveland, OH 44114 <br />INSURER D: <br />INSURER E: <br />INSURERF: <br />CERT!Fl:ATE ns•UMBER: REVISION NUMBER: <br />V THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE 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 />LTR <br />TYPE OF INSURANCE <br />%DOLINSR <br />INVD <br />POLICYNUMBER <br />MMI�UYEFF <br />Y EXP <br />MMIDDATY' <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />CLAIMS -MADE ❑X OCCUR <br />CWPOS17747 <br />0211412016 <br />0211412017 <br />PREMISES Ea oaunence <br />$ 500r000 <br />MFA EXP(Any one person) <br />$ 5,000 <br />PERSONAL&ADV INJURY <br />$ 1,000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PRODUCTS-COMP/OP AGG <br />$ 2,000,000 <br />POLICY DjECT 1:1LOC <br />$ <br />OTHER: <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea aeddenl <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />A <br />ANYAUTO <br />CWPOS17747 <br />02114/2016 <br />02/1412017 <br />BODILY INJURY (Per accident) <br />$ <br />ALLOWNED X SCHEDULED <br />AUTOS AUTOS <br />NON -OWNED <br />X HIREDAUTOS X AUTOS <br />Weracd.rd) E <br />Per aceMent <br />$ <br />S <br />A <br />X <br />UMBRELLA LIAR <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />CWPO817747 <br />02114/2016 <br />02/14/2017 <br />EACH OCCURRENCE <br />$ 2,000,000 <br />rl <br />AGGREGATE <br />$ 2,000,000 <br />DEO <br />I X <br />I RETENTION$ 0 <br />1$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNERNECUTNE YIN <br />W OFFICERIMEMBER EXCDEDT <br />(Mandatory in NH) <br />STATUTE ER <br />E.L.EACHACCIDENT <br />$ <br />E.L. DISEASE -EA EMPLOYE <br />$ <br />E.L. DISEASE -POLICY LIMIT <br />$ <br />Ityea, desadbe under <br />DESCRIPTON OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be etlached it more apace Is required) <br />RE: <br />214 W Wayne St, South Bend, IN 46601 <br />117 S William St, South Bend, IN 46601 <br />123 N Main St, South Bend, IN 46601 <br />o un, nco r.ANCPI I GTION <br />CITYSO- <br />Ci of South Bend <br />City <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />125 S Lafayette Blvd #100 <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />South Bend, IN 46601 <br />AUTHORIZED REPRESENTATIVE <br />©1988.2014 ACORD CORPORAI ION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />