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MARYC-1 OP ID: KL <br />ACC CERTIFICATE OF LIABILITY INSURANCE OATE(MMIDDIYYYY) <br />01106/2017 <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. Oswald Company House <br />INSURED <br />44114 <br />NAMEpVI James B. Oswald Company House <br />PHON. �..,.888-323-1383 INC. Nor. 614-796-7728 <br />NI IMRFR: <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 />INSR <br />LTR <br />TYPE OF INSURANCENOOL <br />sD <br />wv0 <br />POLICY NUMBER <br />OLICY EFF <br />MMIDD <br />POLICY EXP <br />MM/DD/YYYV <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />CLAIMS -MADE FXIOCCUR <br />CWP0817747 <br />02I1412016 <br />0211412017 <br />°PREMISES Ea occurrence <br />$ 500,000 <br />MED EXP(Any one person) <br />$ 5,000 <br />PERSONAL SADV INJURY <br />$ 1,000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PRODUCTS- COMPIOPAGG <br />$ 2,000,000 <br />POLICY PELT LOC <br />OTHER: <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />A <br />ANYAUTO <br />CWPOB17747 <br />02/1412016 <br />0211412017 <br />BODILY INJURY (Per aWdenl) <br />$ <br />ALLOWNED x SCHEDULED <br />HII EOSAUTOS NON OWNED AUTOS <br />X X UTOS <br />PROPERN DAMAGE <br />(Per accident) <br />$ <br />J( <br />UMBRELLA LIAR <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 2,000,000 <br />AGGREGATE <br />$ 2,000,000 <br />A <br />EXCESS LIAB <br />CLAIMS -MADE <br />CWPO817747 <br />0211412016 <br />0211412017 <br />OEO <br />I X I RETENTION$ 0 <br />$ <br />1 <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORIPARTNEMUECUTNE ❑NIA <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory in NH) <br />PER <br />I I ERH <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE -EA EMPLOYE <br />$ <br />E.L.OISEASE- POLICY LIMIT <br />$ <br />Ifyea, describe under <br />DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPE NATIONS I LOCATIONS I VEHICLES (ACORD 101, AddMonal Remarks Schedule, maybe attached If more apace Is requlmd) <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 />_--.--_-----_-- <br />CITYSO- <br />Cif Of South Bend <br />Y <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 />ew�.-1 <br />FJTeee-LVIYHVVRV NVRr'VRMIIVIY. nu uyn o,coc,vvu. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />