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TIMFFIV-nl ANNA ^� 1 ACORO" CERTIFICATE OF LIABILITY INSURANCE DATE (MM1DDfYYYY)06/08/2017 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 policy(ies) must have ADDITIONAL INSURED provisions or 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 endorsement(s). PRODUCER Dan Berry Insurance Agency Inc. 54101 Ironwood Road South Bend, IN 46637 ACT :--_- PHONE Ex1): (574 255-6222 FAx 574 254-2630 ) ;ArgN°)`{ rE-MA- Ebusiness@dbimail.com ENSURER{S) AFFORDING COVERAGE NA€C # INSURER A: United States Liability Insurance Company 25895 INSURED INSURER B : 1NSURERC_- Times Five, LLC dba Linden Grill _ INSURER D : 119 S Michigan St South Bond, IN 46601 INSURER E :- INSURER F : rQVFRAfAFC C:FRTIFIC.ATF NI IMRFR• REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BFLOW 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 __TYPE OF INSURANCE I ADDL SD SUER wVD POLICY NUMBER POLICY EFF M O❑ POLICY EXP LIMITS A. X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR CP2610650 03117r'2017 03I1712018 EACH OCCURRENCF 1,000,000 DAMAGE TO RENTED 5 S Ea occur a ce 1 QQ QQQ ' MED EXP (Any oneperson) 5,000 PERSONAL & ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY [:] PER& LOCI X OTHER, liquor liab $1,000,000 GENERAL AGGREGATE 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTNOS AUTOS ONLY �. AUTO ONLDY Ea acc deCBIb L INGLE LIMIT $ BODILY INJURY fPerperson) BODILY INJURY Per accident $ PROPERTY DAMAGE Per acciJ $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE - AGGREGATE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNERIEXECUTIVE ❑ OFMCFWMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N f A PER OTH- ER —AUATUTE E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE $ _ E.L. OISFASE - POLICY LIMIT DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) r Cr2TICl/`ATC Ur%l RCo r'.AIVC`FI I ATInNI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of South Bend Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1 "4�1_ - I ACORD 25 (2016103) @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD