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1 ® - <br />��oRD CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMIDDIYYYY) <br />112912018 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT. If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the Certificate holder in lieu of such endorsoment(s). <br />PRODUCER <br />NFP Corporate Services (SE), Inc. <br />1901 Roxborough Rd., Ste. 300 <br />Charlotte NC 28211 <br />CONTACT <br />NAME; Debbie Chia one <br />PHONE FAX <br />704 464-4847 Alc No <br />E-MAIL <br />ADDREss: debbie.chiappone@nfi?.com <br />INSURERISI AFFORDING COVERAGE <br />NAIC # <br />INSURER A: Philadelphia Indemnity Ins. Co <br />18058 <br />INSURED GIRMICH <br />INSURER B : Hartford Accident & Indemnity <br />223557 <br />Girls on the Run Michiana <br />51160 Bittersweet Rd., Ste. 202 <br />INSURERC: <br />Granger IN 46530 <br />INSURERD: <br />INSURER E <br />INSURER F <br />r.nVFRerrFC f'512TII='Ir'ATF MIIMFIFR• 1RR7R-.r,7nin 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />SUBR <br />POLICY NUMBER <br />MW�anYYY <br />MM1�DYEXP lYYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />Y <br />PHPK1755036 <br />2/1/2018 <br />2/1/2010 <br />EACH OCCURRENCE <br />$1,000,000 <br />CLAIMS -MADE L11 OCCUR <br />DAMAGE TO RENTED <br />PREMISES We occurrence <br />$ 1,000,000 <br />X <br />MED EXP (Any one person) <br />$ 5,000 <br />AbuselMolestalio <br />X <br />Special Events <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 3,000,000 <br />PRODUCTS - COMP/Op AGG <br />$ 3,000,000 <br />POLICY ❑ PRO- JECT Fx] LOC <br />$ <br />OTHER: <br />I <br />A <br />AUTOMOBILE LIABILITY <br />PHPK1755036 <br />2/112018 <br />21112019 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ 000 000 <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />NON -OWNED <br />X HIRED Ix <br />AUTOS ONLY AUTOS ONLY <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />PEr accident <br />$ <br />$ <br />A <br />X <br />UMBRELLA LIAR <br />X <br />OCCUR <br />PHUB611999 <br />21f12018 <br />21112019 <br />EACH OCCURRENCE <br />$10,000,000 <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED X RETENTION $ lo.ono <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANYPROPRIETORIPARTNER/EXECUTIVE Y❑ <br />22WECEL3349 <br />12/19/2017 <br />12/19/2018 <br />X I STATUTE I I ERH <br />E.L. EACH ACCIDENT <br />$ 100,000 <br />OFFICERIMEMSER EXCLUDED? <br />{Mandatory in NH) <br />N 1 A <br />E.L. DISEASE - EA EMPLOYEE <br />$ 100,000 <br />E.L. DISEASE - POLICY LIMIT <br />$ 500,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />A <br />Property; Special Form <br />Replacement Cost <br />PHPK1765M <br />211/2018 <br />211/2019 <br />Canlenls Limit: <br />Deductible: <br />100,000 <br />500 <br />DESCRIPTION OF OPERATIONS! LOCATIONS! VEHICLES IACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />RE: GOTR 5k event: Certificate holder and the following are included as additional insured(s) as respects to general liability for the operations of the named <br />insured as required by written agreement or permit: <br />Swing -Batter Swing LLC <br />South Bend Cubs <br />501 W. South St. <br />South Bend, IN 46601-2724 <br />See Attached... <br />C-FRTHIPWATF i4ni nFR CANCELLATION <br />SHOULD ANY OF THE ABOVE. DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />The City of South Bend, The South Bend Parks & <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Recreation Dept. <br />and The Board of Park Commissioners <br />321 E. Walter St. <br />AUTHORIZED REPRESENTATIVE <br />South Bend IN 46614-2642 <br />1. l <br />01988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />