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Fax Server 4/6/2017 9:37:38 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE VATEIMfd1U01YYYY) ift s 4/612017 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 INSURE;R(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 endorsemen s . PRODUCER The Horton Group 340 Columbia Place South Bend IN 46601 NaN1TT^., CT Thomas R. Cassad Jr. PHONE 574-334-5500 FAX 574-334-5500 rc No E-MAIL INSURERS AFFORDING COVERAGE NAIGR INSURERA, Medical Protective 11843 INSURED BEACHEA-02 INSURER B :Arnerisure Mutual Insurance Co, 23396 Beacon Health System, [no. Memorial Hospital of South Bend, Inc. 615 N. Michigan Street INSURERC: INSURERO., INSURER E : South Bend IN 46601 INSURER F ; COVERAGES CERTIFICATE NUMBER:289626112 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE tISTEI) 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 )-ypg OF POLICYEFF POLICYEXP LIMITS LTR 1N50 WVD POLICY NUMBER MMVODIYYYY MrNowyYY A X COMMERCIAL GENERAL UABIL17Y 1H002223 12111201 G 12/112017 EACH CCCURWNCE S1,000,000 CLAIMS -MADE OCCUR AMAGETO URITITED P REMISE- Ea 11G 1 e a $50 000 MED EXP (Any one person) $5,000 PERSON LKADVINJURY $1,000,000 GEN'L AGGREGATE UM€F APPLES PER: GENERAL AGGREGATE $3,000,000 X POLICY ❑JE'Gry- LUC PRODUCTS-COMPIOPAGG $3,000,000 $ OTHER: B AUTOMOBILE LIABILITY CA13212592102 81131201E 8/13/2017 COM131NEDSING (Ea aWdenq $ 1,00mo0 ODDLY INJURY (Per person) $ X ANY AUTO ALL OWNEDSCHEAUTDULED aODLYINJURY (Per accident) S X Fi1RFAAUT05 X NON -OWNED AUTOS PROF�RTYDAMAGE (Per acddet?t $ A X UMBRELLALIAR N OCCUR E002223 12/112016 1211/2017 EACH OCCURRENCE s25,000,000 AGGREGATE $25,000,000 EXCESS LIAR CLAIMS-MADF1 DED X RETENTION$25000 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANYPROPRIETOR/PARTNER)E)ECUrIVE ❑ OFFrER/MEMBER EXCLUDED? NIA PER OTT - STATUTE lwR E.LEACH ACCIDENT S E.L DISEASE • EA EMPLOYE $ (Mandatory In NH) if yes, deser€he under DESORPTION OFOPERATIONS below F,LDISEASE -POLICYLIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule. maybe attached if more space is required) Annual Parking Garage License: Centennial, Bartlett and Navarre Garages City of South Band 227 W. Jefferson Blvd. Suite 1400 South South Bend IN 46601 SHOULD ANY OF THE ABOVE➢ESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THEPOLICY PROVISIONS. AUTHORIZE!] REPRESENTATIVE.". O 19B6-2014 ACORD CORPORATION. All rights reserved. ACORD 215 (2014101) The ACORN name and logo are registered marks of ACORD