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Fax Server 4/6/2017 9:37:38 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE PATE [MM10P1YYYY) 1416/2017 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 poltcy(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 NR or Thomas R. Cassad Jr. PHONE 574-334500 nAo a .574-334-5600 E-MAIL INSURER 5 AFFORDING COVERAGE NAIL 0 INSURERA:Medlcai Protective 11843 INSURED BEACHEA-02 INSURERB:Arnerisure Mutual Insurance Co. 23396 Beacon Health System, Ino, Memorial Hospital of South Bend, Inc, 615 N. Michigan Street INSURER C: INSURERD: INSURERE: South Bend IN 46601 INSURER F : COVERAGES CERTIFICATE NUMBER, 289626112 REVISION NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE ISTED BELOW HAVE 13EEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINO 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 OFINSURANCE INSD WVD POLICY NUMBER POLICYEFF MMlDDNYYY POLICY EXP {NMIDDIYW LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR H002223 12/1/2016 12/112017 EACH OCCURRENCE $1,000.000 PREM SESOEa occurrOence $50 000 MED EXP(Aq one person) $6,000 PERSONAL &ADV INJURY $1,000,000 GENt AGGREGATE LIMIT APPLES PER: X POLICY ❑ JE`CT ❑ Lac OTHER: GENFRX- AGGREGATE $3.000,000 PRODUCTS-GOMPIOP AGG $3,000,000 5 B AUTOMOBILE X X LIABILITY ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS HIRED AUTOS)( NOX OWNED AUTOS CA13212592102 811312016 8/1312017 EOMB �E..D0SiNGLE LIMIT $1,000,000 HDDLYINJURY(Per person) 5 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Pet acddenl) $ $ A X UMBRELLA LIAR EXCESSLIAB X OCCUR CLAIMS -MADE E002223 12/1/2016 12/112017 EACH OCCURRENCE s25,000,000 AGGREGATE s25,000,000 DEO IX I RETENTION325000 $ WORKERS COWENSATION AND EMPLOYERS' LIABILITY YIN ANY OFFICERIMEMBER EXCLUDED? PROPRIETOMPARTNERJO(ECUTIVE ❑N!A (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONSbetow PER OTH- STATUTE ER E.LEACH ACC�NT $ EL DISEASE -EA EMPLOYE $ E.LDISEASE •POLICYLIMIT $ ❑ESCRIPTI ON OF OPERATIONS 1 LOCATIONS I VEHICLES (ACRRD 101, Additional Remarks Schedule, may be attached if mote space is required) Annual Parking Garage License: Centennial, Bartlett and Navarre Garages EL"04kil 11120.11r■Jq: PJSh'L"aAr-115IIL•J4 City of South Bend 227 W. Jefferson Blvd. Suite 1400 South South Bend IN 45601 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 O 1988-2014ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) TheACORD name and logo are registered marks ofACORD