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CERTIFICATE OF' LI ILI ' INSURANCE <br />DATE (MMIDDOYYYY) <br />4/2/ p18 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOE'S NOT <br />AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE IPOLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT <br />CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(iesp must be endorsed. If SUBROGATION IS WAIVED, subject to the terms <br />and conditionsof the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu <br />of such endorsement(s). <br />PRODUCER <br />CONTACT" NAME Angel Karbalaeali <br />GIBSON INSURANCE AGENCY, INC. (SOUTH BEND, IN) <br />PHONE (AIC No, Ext): (574) 245-3547 FAX (A/C No): (574) 236-6399 <br />130 S. Malin St., Suite 400 <br />EMAIL ADDRESS: <br />South Bend„ IN 46601 <br />INSURER(S) AFFORDING COVERAGE <br />NAIL # <br />INSURED <br />INSURER A: Mount Vernon Fire Insurance Company <br />26522 <br />INSURER B: <br />Imani & Unidad Inc. <br />914 Lincoln Way W <br />INSURER C., <br />South Bend„ IN 46616 <br />INSURER D: <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 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 INDICATED. <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE <br />ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS„ EXCLUSIONS AND CONDITIONS OF <br />SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />NSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSR <br />SUBR <br />WWVD <br />POLICY NUMBER <br />POLICY EFF <br />IMMIDDNYYY) <br />POLICY IFXP <br />(MMJDD✓YYYY) <br />LIMITS <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE r OCCUR <br />X <br />CI.. 27,2787�B <br />6123120/8 <br />612512t118 <br />PEACH OCCURENCE <br />Pa. Q sENTErrence) ... <br />��tER <br />$1,000,000 <br />- <br />$100.;000 <br />MED EXP (Any one person) <br />$1,00D <br />PERSONAL BADVINJURY <br />$1,000,000 <br />GENERAL AGGREGATE <br />$3,000,000 <br />GENT AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO,- LOC <br />PRODUCTS-COMPIOP' AGG, <br />'See See L-535 <br />$ <br />AUTOMOBILIE <br />LIABILITY <br />ANY AUTO <br />ZI.. OU4NF.D SSHEr7ULED <br />HIRED AUTOS ANp%Cl$W1RdE0POare <br />(E g�NEDt1 INGLE LIMIT <br />$ <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />c,d nl?AfNAGE <br />$ <br />$ <br />UMBRELLA LIAR <br />EXCESS LIAR <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DED I I RETENTION $ <br />$ <br />WORKERS COMPENSASION <br />AND EMPLOYERS„ LIABILITY <br />ANY PROPRIETORIPARTNERlEXECUTIVEY/N <br />(WanSERJM�n NIir EXCLUDED? <br />atory <br />D fl5Ra�PAeFUPERATdON,helow <br />NIA <br />T(}Tt LIhAITS <br />O <br />E.L.EACH ACCIDENT <br />$ <br />E.L. DISEASE -EA EMPLOYEE <br />$ <br />E.L. DISEASE-POL(CYLIMf7 <br />$ <br />ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (See attached Acord' 101 for addlllonal liability Limits) <br />;ity of South wend is an additional insured per CG 2011 04 13. <br />ER11FICNIE HOLDER CANCELLATION <br />ity if South Bend <br />27 West Jefferson Boulevard <br />oath' Bend', IN 46601 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION'... DATE THEREOF„ NOTICE WILL BE DELIVERED IN ACCORDANCE WWITH THE. <br />POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />25 (2010/05) Copyright 1988-2010 ACORD <br />The ACORD name and logo are registered marks of ACORD <br />reserved. <br />