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04/10/10 13:56:40 5742911597 —> 574 Z34 8338 Stacey Gunn Page BBZ <br />OAM iMWPVffYYYI <br />sl - -- CERTIFICATE OF LIABILITY INSURANCE <br />_ _ 0411 arzal $ <br />THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CER'1`00ATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, E)I.TENO OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTINCATE OF INSURANCE DOES NOT CONSTITUTE A CONFRACT BETWEEN nlE ISSUING W3URPR(3), AUTHORI'LEO <br />REPRESENTATIVE OR PRODUGERf AND THC CERTIFICATE HOLDER. <br />IMPORTANT: If the cartificals holder is an ADDITIONAL INSURED, the polioy(los) must have ADDITIONAL INSURED provisions or 6e endorsed. <br />If SUBROGATION IS WAIVED, subj2Lt to the terms and conditlonts of the policy, oortain policW may require an andorsemrrnt. A statement an <br />this certificate does not confer rights to the oellltiCate holder In Ileu of such endormnen s . <br />PRODU_.........,.,...•, ..... <br />Orin StaseyGunrl <br />$tatt0Far.1lsLG.l9uvdoHs .fruc,lg°.k'Fm Ede Guenther Hrurir~.. ,.,_.. 578-291_15P7 Aik.__..__.....--9i-b32 — <br />_...l.,...2".,.,1�------ <br />411 E Ireland Rd Suite 100 yA stacoyqunn5ZhDIm8i1.COm <br />South Bend, IN46514• INYU,RRRts)aFPaRUING 0OVERAGq — NAI4N <br />IusuRElt A: State Farm Fire 811d Casualty Company 26143 <br />J Weldy LLC 1N5UrieRc_ <br />131 $ Michigan St <br />South Bond, IN 415fJ01 UiSItRER H : - <br />IrvWIM P <br />Cr1VDRAiMRR r_r-RTINWATR MIJWWO• 12VVIRIAN NriMRFQ, <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN IS-$UEU TO TmE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY REOUIREMENT, TCRM OR CONDITION OF ANY CONTRACT OR OTHER DOCI)MENT VOTH RtiSPCCT 7O WHICH THIS <br />CERTIFIC.ATF- MAY DE ISSUED OR MAY 01,0TAIN, THE INSURANCE; AFFORDED DY'rHE POLICIIEv DESCRIED HCREIN IS SUBJECT TO ALL THE TERMS, <br />EXaLISIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY RAVE- BEEN REDUCED BY PAID CZAR 48, <br />'RYR a pA;�rraR 0 L POI.i�CY T:Y <br />TYFEOFINSUAAN�e LIMITS <br />P-1C- NyM38t[- -.---' .'i: OWN. <br />(;OMMERCIALOKNERALLIABILITY <br />I <br />EnaF;rxc�A�It�Ncc <br />t 1,D09:DDb <br />f <br />I <br />Ti'7ifut"" f` GCI'RENTES""'} <br />1,0i1 <br />m <br />CLAINiu rdADE JfNj CJCGUk <br />..R `I,IAl�tt„�ke.d!c.JanGA,� <br />1000 <br />1 — <br />i <br />$ 5,000 <br />? <br />MR) Path (Any mw PK°M)) <br />t <br />8a•(�a-Tlii7-9 <br />U8rb1r�0tr <br />bt11011Zb18 <br />s <br />----- -r <br />IPERSaNAL&ADVINJURY <br />GzN'l, AOGREGATF. LIMIT APPLIPA PER' <br />rEnrEZAL Ap4RCF;ATF. <br />_Z,DQ_Q.ObD <br />& 2.00D,401) <br />- POLICY M J eT I.� i.00� <br />PiEGOI]LT$ • C(]MPfr,W AG3 <br />S 2,000-000 ry <br />CITH <br />3 <br />.� <br />AlfiOMOMMEUAB{WTY <br />..W <br />' _ <br />C' M IIVFI) INQLRLIMIT <br />F <br />.a rsoudenl <br />.... <br />f 5 <br />ANYAIITO <br />UOPILYINJURY(PwPeroO(o) <br />;4 <br />O'ATfe6 '+CFIEi?r]LED <br />AIIr[CjjS QNt,Y AIITIJS <br />l <br />e <br />U(][}ELY INJURY {P9f grt:ld9rx} <br />l S .. <br />Nlit£r[T 140N•UN'NL.!7 <br />i <br />'sICL1?ER><Y <br />f�AMAraE <br />M <br />• A4C1ti TUNLY IA1)Tf)SONLY <br />jihrrGc�Actr: ._,.,_,.—_,._..�.,,.•�,,,�,.,,",,,_...._.___ <br />t <br />r <br />UMBRELLA Loci 7C{ I)R <br />#J4C I OCGVRRENt;ki <br />i <br />ExC@SS URA G! gIN8d1a"JE <br />7'CiOR Mi# tTl <br />....__. <br />3 <br />RiTENTiC1hr t <br />';1NPRKE"COMpENSATION� <br />; <br />AND EMPLOYERS, WAMLrTY <br />#ANYPROPRIETOFYPARTW---Rlr.KE(]UTiVE r�"'"H'j,NrA <br />I=L.FrLi:HACCIDGif'C <br />3^•_ ._.—._.. <br />Orr•TCERR,'IEMBER J(C,t,UV.:07 <br />S <br />, <br />�wlntklmlolq(IQUJyJ)D <br />{Flantlalory In NN) <br />E716EASG-EA GfiIP1.0Y$E <br />S <br />ulkdtl( <br />OFopt'R )9Uv,Stwl,rri <br />? <br />E-1-DISC-Ase.P01,CYUMIT <br />5 <br />PiSCRN'1lONOP6PERATIROWLOCATIONS JVEHICLe$ IACURD101,AddidoAllRemarhStrrcdyfn,FrinyDoF0lclhtd0rmmspaoelsrogWr*d► <br />Pizzo Restaurant <br />C1=01rirIrATr- unl IN= rAul^Cl I ATIAM <br />SHOULD ANY OF THE A..00VE OE90910110 POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, N4TiCF WILL BE DEUVoRED IN <br />City of South Bond <br />1045 W Sample St <br />.South $@nd, IN 40019 <br />ACCORDANCE Vd7N THE POLICY PROVIBI <br />11110C11PL61NTAT F � <br />7L.r�-wL' -- ---, <br />e, 7888-2 6 JCORD CORPORATION. All right* reserved. <br />ACORD 25 (2016103) The ACORD name and [ago are registered marks of ACORD <br />tr4l`tpa W449.12 0-14-20118 <br />