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COYNIF-3 OP ID: MG r - ��1� CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDDIYYYYI 01/31/2018 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 440-461-1101 Todd Associates, Inc. 23825 Commerce Park, Suite A Beachwood, OH 44122 Randy J. Cumley NC RAP CT Randy J. Cumley PHONE 440-461-1101 FAX 440-446-0192 (A/C, No, Ext): IArC, No): ADaRIESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Valley Forge Ins. Co. 20508 INSURED Mary Coyne Investments, LLC Coyne Investments Ltd. 1428 Hamilton Ave INSURERB:American Casualty Co.ICNA 20427 INSURER G:CNA Financial Corp. 20443 Cleveland, OH 44114 INSURERD: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER' 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�TYPE LTR OF INSURANCE DDL INSD UDR WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP IDDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR 6045941880 02/14/2017 02114/2018 _ EACH OCCURRENCE 1,000,DOD $ PREMISES DAMAGE T�oNcT1EDnCe $ 500,000 GEN'L MED EXP An ane Verson 000 $ 15,— PERSONAL&ADVINJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO-LOG OTHER:13 GENERAL AGGREGATE 2,000,000 PRODUCTS-COMPIOPAGG 2,000,000 $ AUTOMOBILE LIABILITY X ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS RffiD ONLY AUOP611WN OY 6045941894 02114/2017 02114/2018 COMBINEDSINGLE LIMIT Ea accident 1,000,000 $ BODILY INJURY Per person)$ BODILY INJURY Per accident $ �OaP CRIYt AMAGE Pe as $ $ C X UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE GUE6045941913 02/14/2017 02114/2018 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DFD TX RETENTION$ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETORIPARTNERIEXECUTIVE ❑ ({J anda(ory In NH) PXGLUDED7 If yes, describe under DESCRIPTION OF OPERATIONS below NIA SER TE OTH- E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ _T I CJIP{f111i(°Iaft01P A JOU 161§AenON)LVE�S (ACORD 101, Additional Remarks Schedule, may 6a attached If more space is required) .1123 N Main St, JSiouJthUBtf"ient3d, IN 46601 1 CITY -SOB SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend ACCORDANCE WITH THE POLICY PROVISIONS. Michelle Adams Business License Administrator 227 W. Jefferson Blvd. AUTHORIZED REPRESENTATIVE South Bend, IN 46601 (rf I � ACORD 25 (2016/03) ©1988-2015 AGORD CORPORA I ION. All rignts reservec[. The ACORD name and logo are registered marks of ACORD