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MARAMIS-01 KBLOSS CERTIFICATE OF LIABILITY INSURANCE DATEIMMlDDIYYYY) 0612612017 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 endorsements). PRODUCER I st Source Insurance, Inc. 6909 Grape Road Mishawaka, IN 46545 INSURED Maranatha Missionary Baptist Church 1819 Prairie Ave South Bend, IN 46613 COVERAGES CERTIFICATE NUMBER: NONEAc- Kris Blosser A-----_._._..,......._.... _.._..m._, (Arco, No, Exq: (574) 271-5200 _ FAX , No):(574) 271.5240 E-MAIL blosserk@istsource.com ADDRsS -- - - . - — -- --- ----- IN5UiRER(S} AFFORDING COVERAGE NAIL f INSURER A, NSI / West Bend Mutual Insurance INSURER B INSURER C : INSURER D : INSURER E : INSURER F : REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 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. WSR LTR TYPE OF INSURANCE ADDL NSp SUER WLD POLICY NUMBER POLICY EFF rpp POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X A311686 08I0512017 08106l2017 EACH OCCURRENCE $ l oo,o0o DAMAGE TO RENTED PR.(ima occurrence)_..._ MISES. MED EXP (Any one erson} 900,000 _$... .-......... ............. ._ . ........_ $ Excluded PERSONAL& ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY ❑ PJPRO- POLICY F] LOC OTHER: GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMPIOPAGG $ 3,000,000 $ LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS _ AUTOS ONLY AUTOS ONLY MDINED SINGLE LIMIT rAUTOMOBILE accident $ BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PROPERTY DAMAGE UMBRELLALIAB OCCUR EXCESS LIAB CLAIMS -WADE DE D RETENTION $ EACH OCCURRENCE $ AGGREGATE $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFF€CERIMF MRFR EXCLUDED? andatory n NH) If yes, describe under DESCRIPTION OF OPERATIONS below !! f I NIA PER OTH- ,,,_,,,,_ „,P5TATUTE _ __— ER E,L, EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE —- - — - $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schadute, maybe attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of South Bend tY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 227 W. Jefferson South Bend, IN 46601 AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) 9)1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD