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A <br />� EN CERTIFICATE OF LIABILITY INSURANCE <br />FDATE(MMfDDrrwY) <br />a4120/2018 <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 pollcy(ies) 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 endorsement s . <br />PRODUCER <br />The Leadership Insurance Agency, Inc. <br />52303 Emmons Road <br />Suite 31 <br />South Bend IN 48637 <br />MOT David Giles <br />FAMP, • 574-277-1611 FAx 574 273.4657 <br />Aoaggm davIddIleadershIpins.corn <br />INSURER(S) AFFORDING 00YRRAGE <br />NAIC# <br />INSURER • AUTO -OWNERS INS CO <br />18988 <br />INSURED <br />The General Deli LLC <br />609 E Jefferson Blvd <br />South Bend IN 46617 <br />I SU E <br />INSUR R : <br />INSURER <br />INSURER E <br />INSURER <br />ne�tfbnw�±be. /�CbTIC1n ATC 1.1116ACCD. - Rr-wgi m r11l7MBFR' <br />W THIS ,ISTO 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 />1NSR Iis <br />TYPE OF INSURANCE <br />S BR <br />POLD ICYNUMBE <br />POLIG EFF MM <br />POLICY <br />LIMITS <br />A <br />x <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMB•MADE FRI OCCUR <br />Y <br />N <br />00013483 <br />10/09/2017 <br />10/09/201 B <br />EACH OCCURRENCE <br />$ 1000000 <br />RENFFU <br />s 300000 <br />MED EXP Lft onepawn) <br />$ 10000 <br />PERSONAL A ADV INJURY <br />s 1000000 <br />GEMLAGGREGATE UMITAPPLIES PER: <br />POLICY jEpT LOG <br />OTHER., <br />GENERAL AGGREGATE <br />s 2GO0000 <br />PRODUCTS -COMP10P AGO <br />s <br />i <br />AUTOMOBILE LIABILITY <br />ANYAUTO <br />OWNED SCHEDULED <br />HA REODS ONLY UTN.pyOB <br />OE,lED <br />AUTOS ONLY AUTOSONLY <br />COMBINED SINGER rr <br />(EA 299iftoll <br />S <br />BODILY INJURY (For Pmon) <br />s <br />BODILY INJURY (Pat ) <br />s <br />ROPFRTYDAMA{iE <br />P. <br />y <br />3 <br />UMBRELLA LLAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />S <br />AGGREGATE <br />DEb I I RUSNTION <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYER& LIABILMY <br />ANY PROPRIETORMARTNERI&XECUTiVE Y j <br />OFFIC£RIMEMBER EXCLUDED? <br />(Mandatory In NH) <br />Nyyees deeodbe wider <br />DESL�RiPTION OF OP IS 6alow <br />NIA <br />PE OTH- <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE • EA EMPLOYEE <br />s <br />E.L. DISEASE • P UGY LiMrr <br />s <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be allached If more apace 1e raquirad) <br />City of South Bend Is additional insured with respect to General Liability. <br />r%AKI r-1 I ATInKI <br />V FrI\ila IV/11ti IlVtiv�l♦ <br />— --- <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of South Bond <br />1400 County City Building <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORI7.E0 REPRESENTATIVE <br />M <br />South Bend IN 46601 <br />Fax: Email: <br />ACORD 26 (2016/03) <br />qP TlJrit!-"LU7n ACUKU t;VnrUM I IUIM. n11 ngnls Idae,l%FWU- <br />The ACORD name and logo are registered marks of ACORD <br />