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D® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 0611512 01 a 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 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 certificate holder in lieu of such endorsement(s). PRODUCER CNAME:O TACT Michelle Wasoski Gibson Insurance Agency, Inc. PHONE (800) 814 2122 FAX A!C No El No : (800) 8362122 130 S Main St, Ste 400 E-MAIL mwasoski@gibsonins.com ADDRESS, INSURER(S) AFFORDING COVERAGE NAIL $ PO Box 11177 INSURERA: Cincinnati Specialty Underwriter 13037 South Bend IN 46601-0177 INSURED INSURER B : Urban Adventure Games, Inc, INSURER C : PO BOX 11463 INSURER D : INSURER E: INSURERF: South Bend IN 46634 COVERAGES CERTIFICATE NUMBER: 7128118 - 7129118 REVISION NUMBER: 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 CONTRACT OR 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. LTR TYPE OF INSURANCE AULIL INSD WVO POLICY NUMBER MMIfIDIYYYY (MMUMOnfYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS.MADE x OCCUR DAMAG PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1,00D,000 A CSU0101718 07/28/2018 07/29/2018 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY 0jE7 LOG PRODUCTS -COMPIOPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per arx'ldent $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAR OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAR DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN 8TRTUTE ER " E.L. EACH ACCIDENT $ ANY PROPRIETORIPARTNERIFXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ NIA E.L. DISEASE- EA EMPLOYEE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space Is required) Certificate holder is additional insured with respect to general liability coverages as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend, Indiana ACCORDANCE WITH THE POLICY PROVISIONS. 227 W. Jefferson Blvd AUTHORIZED REPRESENTATIVE South Bend IN 46601 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD