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EMBAOFT-03 MCHO ACUR[D� �� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 1/26/2018 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 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 (301) 231-6447 NAME: ONTACT Martens -Johnson Insurance Agency, Inc 6227 Executive Blvd Rockville, MD 20852 PHONE FAX AIC Exl : AIC No IL E-MAIL ADDRESS; INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Philadelphia Insurance Companies 6777 INSURED Embassy of the Republic of Rwanda INSURER B : INSURERC: 1875 Connecticut Ave NW #41$ INSURER D : Washington, DC 20009 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIODfYYYY POLICY EXP MMIDDfYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE -DAMAGE $ 1,000,00 CLAIMS -MADE ] OCCUR Y N PHPK1770031 1/3112018 1/31/2019 TO RENTED PREMISES La occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL& ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X JE PO - POLICY LOC PRODUCTS -COMP/OP AGO $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COEa acMBcident INED SINGLE LIMIT $ 300,000 BODILY INJURY (Per person) $ A ANY AUTO N N PHPK1769918 113112018 1131/2019 BODILY INJURY (Per accident) $ ALL OWNED X SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4,000,00 HCLAIMS-MADE AGGREGATE $ 4,000,00 A EXCESS LIAR N N PHUB615959 1/3112018 1/3112019 DE❑ I X I RETENTION $ 10,000 $ WORKERS COMPENSATION EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE PER OTHAND STATUTE ER E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Excess policy is over General Liability policy only. Certificate Holder is listed as Addlitional Insured on the listed General Liability Policy. This is for a 1 day event on April 27, 2018 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Board of Public Works 227 West Jefferson THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1316 County- City Building South Bend, IN 46601-0000 AUTHORIZED REPRESENTATIVE ACORD 26 (2014101) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD