Non Res Block Party - Historic Landmark Foundation of Indiana

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INrIII AN.n1 SF ROWN T ACORO" ��. CERTIFICATE OF LIABILITY INSURANCE DATE (MM1ODlY1'YY)ov1s12o1s 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 pollcy(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 Gregory &Appel insurance 140 N Cap€to Suite Insurance Indianapolis, IN 46202 CANT A E:CT PHONE 31 634-7491 FAx (ArC,Na, Ext): ( 7) {Arc, Nol:(317) 634-6629 Ap AIL . corp@gregoryappet.com INSURERS AFFORDING COVERAGE NAIC N INSURER A: Zurich American Insurance Co 16535 INSURED INSURER 13: Accident Fund Insurance Company of America 10166 INSURERC: Indiana Landmarks INSURER D : 1201 Central Avenue Indianapolis, IN 46202 INSURER E INSURER F : r'n%/F:PAr3PC r'FRTIFIC:ATP NI IMRPR• 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, INSR Llkn Ty PE OF INSURANCE AnDL SUBR D POLICY NUMBER POLICY EFF IDD POLICY EXP M DD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAWSWADE ❑X OCCUR CP00219870 08/31/2017 08/3112018AMAGETOREMISESEaENTEDo OCCURRENCE $ 1,000,000 [EACH ce $ 100,000 ED EXP (Any oneperson) $ 10,000 PERSONAL& ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO LOG OTHER: GENERAL AGGREGATE S 2,000,000 PRODUCTS-COMPIOPAGG 2,000,000 A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X AUTOS ONLY X 000SONL� CP00219870 08/31/2017 08/31/2018 COMBINED SINGLE LIMIT $ 1,000,000 BODILY INJURY fPerperson) $ BODILY INJURY Peraeddeni $ PorraccitlenDAMAGE $ $ A X UMBRELLA LIAD EXCESS LIAS X OCCUR CLAIMS -MADE AUC1072172 08/31/2017 08/3112018 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DED I X I RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN E ANY PROPRIETORIPARTNERIEXECUTNN FFICERIMIEMBER EXCLUDED? Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N 1A WCV5007125 08/31/2017 08/31/2018 X I PER OTH- STATUTE ER E.L. EACH ACCIDENT 500,000 $ E.L. DISEASE - EA EMPLOYEE 500,000 $ E.L. DISEASE - POLICY LIMIT 500,000 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) The City of South Bend is included as Additional Insured per Policy Forn U-GL-1345-B CW (04/13) with respects General Liability according to the terms, conditions, and exclusions within the policy regarding Indiana Landmarks use of North Street in South Bend for a flea market event on July 21, 2018. C:FRTIFIr'ATP Ian) nPR CANCF_LEATION 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. ATTN: Marcia Qualls 4th Floor, County City Bldg 227 W Jefferson Blvd AUTHORIZED REPRESENTATIVE South Bend, IN 46601 ACORD 25 (2016103) O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD