Procession - South Bend Riley High School Homecoming Parade

Home Browse Search

A �7-1 0 CERTIFICATE OF LIABILITY INSURANCE DATE (MM 1YYYY) os113/2012aie 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(les) 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 ondorsement(s). PRODUCER CONTACT Susan Thompson NAME: Laven Insurance Agency Inc. aye No Ext ; (574) 291-5510 FAX.,,): (574) 291-8505 E-MAIL suet@Iaveninsurance.com ADDRESS: R O. Box 2379 INSURERIS) AFFORDING COVERAGE NAIC N SOUTH BEND IN 46680 INSURERA: Peerless 24198 INSURED INSURER B : Indiana Insurance 22659 South Bend Community School Corporation INSURER C : INSURER D : 215 S. Dr. Martin Luther King Jr. Blvd. INSURER E : INSURER F : South Bend IN 46601 COVPRAGES CERTIFICATE NUMBER: 18-19 Master 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 MAYBE 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, ILTR TYPE OF INSURANCE tNgp yyyp POLICYNUMBER POLICY EFF MMfODlYYYY POLICY EXP MM1ODfYYYY LIMITS X COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR DAMAGE T PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 15,000 PERSONAL BADVINJURY $ 1,000,000 A Y CBP9381640 03/13/2018 03/13/2019 GEN'LAGGREGATE LIMIT APPLIES PEW GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ JECT PRO- ❑ LOC PRODUCTS - COMP/OP AGO $ 2,000,000 I Employee Benefit Liability $ 1,000,000 OTHER; I AUTOMOBILE LIABILITY CEa OMBacidanlNwc;2NNGLELIMIT a $ 1,000,000 BODILY INJURY (Per person) $ ANYAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED NON -OWNED AUTOS ONLY IXAUTOS ONLY BA9143886 03/13/201 B 0311312019 BODILY INJURY (Per acciden[) $ PROPERTY DAMAGE Per accident S X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 10,000,000 B EXCESS LIPS CLAIM&MADE CU9719162 03/13/2018 03/13/2019 M AGGREGATE $ 10,000,000 X DED RETENTION $ 101000 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE ER STATUTE ER E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ NIA {Mandatory in NH) E.L. DISEASE- EA EMPLOYEE $ E,L, DISEASE- POLICY LIMIT $ ifyes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Event: Homecoming Parade September 21, 2018-Riley High School Certificate holder and the City of South Bend are named as additional insureds. ��warLa.I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Board of Public Works ACCORDANCE WITH THE POLICY PROVISIONS. 227 West Jefferson Blvd AUTHORIZED REPRESENTATIVE 1316 County City Building South Bend IN 46601 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD