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! � CERTIFICATE CIF LIABILITY INSURANC DATE(MM1llDiYYYY) 46/0312018 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 lleu of such endorsement(s). PRODUCER �C�PAM,TiC Michelle Harrell PHONEExl). nAIC 'No ; 574 674-9582 Randy Lellaert Agency Ino _..� ADD�ESS 410 Lincoln Way VV INSURER 8 AFFORDING COVERAGE � NAIC iR_.__..,..,. INSURER A: Illinois Casualty Coma Osceola IN 46561 _..._._.—_ — INSURED INSURER B ; Erie Ins. Co -INSURER C: _ .... Chicory Of South Bend, Inc 106 E Jefferson Blvd #103 INSURER D : _..w__.. _._._.. INSURER E: South Bend IN 46601 INSURERF: COVERAGES CERTIFICATE NUMBER. KEV161UN NUMIULK, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TIME POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 OFINSURANCE ADDL SUBR POLICY NUMBER ..-POLIOY EYY POiDc&sflYY LIMITS LTR' X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,040!,004 X CLAIMS -MADE 0 OCCUR PR M� ES� aEoNccu r nce $ 1,040,040 A N N BP34927 0312812018 03128/2019 PERSONAL & ADV INJURY $ 1 „400,000 GEN'LAGGREGArE _ LIMIT APPLIES PER: POLICY F JF 7 LUC OTHER: GENERAL AGGREGATE $ 2,000,000 ,71 PRODUCTS - COMPIOP AGG $ 2,444,000 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED '* r SCHEDULED AUTOS LLNJ AUTOS NOWOWNED HIRED AUTOS AUTOS N N Q07-0630669 07/0612017 07/061201 g COMBINED SINGLE LIMIT �Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ s UMBRELLA UAS EXCESS LIAR OCCUR CLAIMS•MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS GOMPENSA I UN AND EMPLOYERS' LIABILITY S1iI ImKJT if ANY PROPRIETORIPARTNERIEXECUTIVE �Y!N EL EACH ACCIDENT $ 100,000 B OFFICER(MEMBEREXCLUDED4 L"' i NIA N Q677800181 3/28/2018 3/28/2019 (Mandatory In NH) E,L. DISEASE -EA EMPLOYEE $ 100,000 II' os describe under D S RIPTION OF OPERATIONS below E.L. DISEASE - POLICY I.AMIT $ 500,004 A Liquor Liablty N N LQ1064070 05/1912017 05/16/2019 $1,000,000 DESCRIPTION' OF OPERATIONS/ LOCATIONS i VEHICLES (ACORN i0l, Additnal Remarks, ,ghPduI may he attached If more space Is required) cap 1CNr*Arr iUr"r MM (.AKV..I-I I ATIONI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of South Bend 227 W Jefferson Ste 1316 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. South Bend, In 46601 AUTHORIZED REPRESENTATIVE w � fir. �-.�..:;r,,.°��-„�_.. •'�h^��.�':�* —, k a,x: LI air .uJ rOuts-zwq muvmL.r+. umt'urim I rvi c mi' r iyriat� i uzSvr vay. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD