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ACf7R®® CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM DD YYYY) <br />02/1512017 <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(les) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />The Leadership Insurance Agency, Inc. <br />52303 Emmons Road <br />Suite 31 <br />South Send IN 46637 <br />CONTACT <br />NAME: <br />PHONE 574 277-1611 Arc No:, 574 273-4557 <br />nD@Res& leadership@leadershipins.com <br />INSURERS AFFORDING COVERAGE <br />NAICN <br />INSURER A: AUTO.OWNERS INS CO <br />18988 <br />INSURED <br />The General Deli LLC <br />609 E Jefferson Blvd <br />South Bend, IN 46617 <br />INSURER S! <br />INSURER C: --- <br />INSURER D: <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />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 />1NTR <br />TYPE OF INSURANCE <br />DDLS <br />lam <br />BR <br />38M <br />POLICY NUMBER <br />MMyDDlYEYYFI' <br />MMADONYP <br />LIMITS <br />A <br />X <br />COMMEND GENERAL LIABILITY <br />CLAIMS -MADE ® OCCUR <br />Y <br />N <br />09013483 <br />10/0912016 <br />10/09/2017 <br />EACH OCCURRENCE <br />S 1000000 <br />DAMAGE TO REIN <br />PREMISES Iliaomurance <br />S 300000 <br />MED EXP (Any oneperson) <br />S 10000 <br />PERSONAL a ADV INJURY <br />S 1000000 <br />GENT AGGREGATE LIMIT APPLIES PER: <br />X POLICY PRO- <br />JECTLOC <br />OTHER: <br />GENERAL AGGREGATE <br />S 2000000 <br />PRODUCTS-COMP/Op AGG <br />s 2000000 <br />1 <br />$ <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NONAWNED <br />AUTOS ONLY AUTOS ONLY <br />COMBINEDSINGLE LIMIT <br />E aoddenl <br />S <br />BODILY INJURY(Por poison) <br />$ <br />BODILY INJURY (Per accident) <br />It <br />PROPERTY DAMAGE <br />I Per eccidenl <br />$ <br />$ <br />UMBRELLA LM13 <br />EXCESS LIAB <br />OCCUR <br />CIAiMS-MADE <br />EACH OCCURRENCE <br />S <br />AGGREGATE <br />$ <br />DEB <br />I <br />I RETENTION$ <br />I <br />S <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />OFFICERIMEMBEREXCLUDED?XECUTIVE YQ <br />(Mandatory in NH) <br />Ir yes, dosaibo undor <br />DESCRIPTION OF OPERATIONS bvivx <br />NIA <br />N <br />09205698 <br />10109/2016 <br />10109/2017 <br />X SE TOTH <br />OTE <br />' <br />E.I.EACBAcc10ENT <br />$ 100000 <br />E.L. DISEASE - EA EMPLOYE <br />$500000 <br />EL DISEASE -POLICY LIMIT <br />S 100000 <br />DESCRIPTION OF OPERATIONSI LOCATIONSI VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is roqulrm) <br />Location 609 & 613 E Jefferson Blvd South Bend, IN. 46617 - <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of South Bend <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />1400 County City Building <br />AUTHORIZED REPRESENTATIVE <br />South Bend IN 46601 <br />Fax: Email: <br />ACORD 25 (2016/03) <br />B 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />