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—^� LEPER-1 O06102ATE /0rr a5roz1zol8 ACORO' CERTIFICATE OF LIABILITY INSURANCE �.....� 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 pol€cy(ies) must have ADDITIONAL INSURED. provisions or 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.cartificate holder in lieu of such endorsements . PRODUCER 574-277.0234 HOLLAND INSURANCE GROUP 54081 N. Ironwood Rd., P.O. Box 6458 cONTncr Ray Barson PHONE 574.277-0234 Arc No, Ext : FAX 574-277.02.86 Arc, No): •M South Bend, IN 46660-6458 Ray Barson INSURER(Sl AFFORDING COVERAGE NAIC# INSURER A: PROPERTY OWNERS 32905 INSURED PEGGS of South Bend Inc. Peg Dalton 127 S Michigan INSURER 0 : INSURER C i INSURER D South Bend, IN 46601 .............. . INSURER E INSURER F: r-nVFRAryFS 1 FRTIFI(.ATF NI IMRFR- RFVICIfSN NI IMRFR• 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 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 OF INSURANCE SUB POLICY POLICY NUMBER NIMIDDlYmi POLICY EFF POLICYLTR EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR y 09026221 06/01/2018 06/0112019 EAC OCCURRENCE $ 11000,000 OAMAtGE�To RENTED 300,000 MED EXP An r cne erson 5 10,000 PERS NAL&ADVINJURY 3 1,000,000 MGGE 'L AGGRE TE LIMrr APPLIES PER: POLICY L] jpef El LOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMPIOPAGG S .2,000,000 AUTOMOBILE LIABILITY ANYAUTO OWNED SCHEDULED AIURRT��OppS ONLY AUTOS p ONLY AUTO ON Y COMBINED SINGLE LIMIT BODILY INJU Y Per erson S BODILY BODILY INJURY Per accident S �� R t AnGE $ UMBRELLA LIAR EXCESS LIAR µ OCCUR CLAIMS -MADE EACH OCCURREN E $ 'AGGREGATE OEO I I RETENTION$ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPR€ETORMARTNERIEXECUTWE Y r N andatory nBEREXCLUDED? If yyos, describe under DESCR P lb OF ERATIONS below NIA 09111406 0610M018 06101/2019 �( PER . OTH• E L EACH ACCIDENT 100,000 E.L DISEASE -EA EMPLOYEE 1Q0,QOQ E.L DI EAS - OLICY LIMIT tiQ0,Q0Q DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Addlllona] Remarks Schedule, may be attached if more space Is required) City of South Bend is Additional Insured on General Liability City of South Bend 211 N Michigan Street South Bend, IN 46601 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE Ray Barson ACORD 26 (2016103) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD