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08/18/2017 19:33 15742340338 <br />MARTIN <br />PACE 05 <br />CERTIFICATE OF LIA <br />THIS CERTIFICATE 19 ISSUED AS A MATTER OF INFORMATION ONL <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEM0 <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CON$rn <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: U Ilse aerdflcate holder is an ADDITIONAL INSURED, the <br />the berms and CorrdMons of the po)loy, certain pollefin may "uhs an I <br />carffftste huklor In Ilsu of such endorseme a . <br />PROOMR <br />GLID90n tnsnreurros AUSD03f, Ina, <br />130 B wain St, Ste 400 <br />FO Box 11177 <br />South Hand i!t 46601--0177 <br />INSURID <br />South Bead Heritaga $0undati0n, Inc. <br />903 Linculnway want <br />South Bond IN 4661 <br />.BILITY INSURANCE DAIM(MWOD/YYYY) <br />$/9/2017 <br />Y AND CONFERS NO FIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />, EXTEND OR ALTER THIS COVERAGE AFFORDED BY THE POLICIES <br />TE A CONTRACT BETWEEN THE ISSUING INSURER(ft AUTHORIZED <br />pollay(les) must be endorsed. H SUSVO AMN IS WAIVED, subject to <br />ndorssment. A statement On this cortft ate does not confer rlehbe to the <br />�h:rsss Burns <br />FROM EI., (800) 814-2122 F (soo)a9e-?i2Y <br />tburn aegribsonine , Cow <br />INWMNSJ AFFORDINOCOVERAm6 <br />kAlt:/ <br />NBUFULRA i fr3r4at:i Zn Co <br />1 If77 <br />IkeURIiR B :CinoinnatA Xad Co <br />23280 <br />INeUNiR C <br />ffi3UllEIt C r -- <br />INSURER fa . <br />COVERAGES CERTIFICATE NUIILRER:3-2-17/18 Liability 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 POLICIFS. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />A <br />X <br />00U NIMCIAL ORNIIPAL LI AIMUTY <br />CIA€M&M OF � OCCUR <br />-- <br />ta1GH4ETQRRENTE <br />b 1rOno 000 <br />s s4D,0oo <br />X <br />XCO —_-- <br />YPv0232616 <br />3/2/2017 <br />3/2/201e <br />M� El(a (A one ) <br />-- <br />3 � 5,000 <br />X COntravtual Lis"ZL&X <br />P1R40NAL&ADVtNJtIRY <br />i 11000,000 <br />GHN1ai2AL AL30REQ4"YS, <br />; Y�2.00 D , 000 <br />0214 L AOOREOATE UMrr APPLIES PER: <br />POLICY 1"1JEGT I�(ILOC <br />PRODUCTS -COMPIOPAGO <br />s 2,000,000 <br />OTHFA: <br />ammyee Bares <br />i 1,000,000 <br />A <br />AURIMMILF-LIADI'IM <br />ANT AUTO <br />ALL OWNAUTOG ED <br />AUUTOAgSCHEDULFD <br />aPpD232Blfi <br />3/2/2017 <br />3/2/201$ <br />INGLE UFATTs <br />1,000,000 <br />00DILY INJURY (par parson) <br />i <br />BODILY INJURY (AwsocdeM) <br />i �— -- <br />NO <br />X HIREDAUY03 X AUTOSWNED <br />eOPERTY <br />"" <br />i S,000 <br />i S 044 000 <br />A <br />UMMUAUA11 OCCUR <br />X OM M LLAB CLAIM&MADE <br />IXPP0232819 <br />Madl € malxiw <br />EACH OCCURRRNOF <br />A_GGREGA_It <br />i 5.000.000 <br />0 <br />WOMER3 COMP L42ATION <br />ANOlYHLpY1LR¢' LJAifrlrrY YIN <br />AN`(PROPMETORrPARTNERIFXECiITiS <br />0fl9CV"9M49R EXCLUDED? � <br />jlf nd►ewy In HH) <br />— <br />Y T R <br />i <br />1$ <br />MIA <br />s1aCO2N7x9303 <br />3!2/2017 <br />9/2/2017 <br />3/2/2010 <br />3/2l2019 <br />_ELEACH ACGIDEINf <br />b _ A00'90a <br />E,L, DISEASE - EA EMPLOYPE <br />s 106 - Ann <br />DUMP Mm or DPERAroNs! 1n0ATma I V!I}ICLas (AWRO 101, Addt"MI Rem**& Rdbodtft may IM aliadhed If man pan Ia MWIFadl <br />Certifioatek holder le addiUonft], iraalnred with respeat to ganaral liability a0vrragan rvg*rd11tq work <br />performed by the 1noureld. <br />publicwkb@aouthbondin.gov <br />City of South 94nd <br />Sodrd of Public Works <br />227 V Jefferson <br />2316 County City Bldg <br />South Bond, IN 46601 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE 9XPIRATION IDATE THEREOF, NOnCE WiL4. BE DELIVERF-D IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED RIrRL'r WAM9 <br />Ina Agency/TRESA <br />Ig IVOO-Y074 AGUKP GORPOKA17ON. All 110hb reSAIVBd. <br />ACORD 26 (2014I01) The ACORD OOMO and logo are Mglatored marks of ACORD <br />IN11025,zn+eai% <br />