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'iCesORUi CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) --� 06/19/2018 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 INSURERIS), 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 WANED, 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 endorsements . PRODUCER CONTACT Dab Childs NAME: Sta—feFarM Deb Childs Agency PHONE IAIC. No. Evil: 574-255-3000 F,uc No): 574-958 1780 16845 Douglas Rd AE ILE 5: deb 4QdebChildS.CQm INSURE S AFFORDING COVERAGE NA1Cp Mishawaka, IN 46545 INSURER A,. State Farm Fire and Casualty Company 25143 INSURED tNSURHR 8 INDIANA BLACK EXPO INSURER C : SOUTH BEND CHAPTER INSURER D PO BOX 335 INSURER E SOUTH BEND IN 46624-0335 INSURERF, COVERAGES CERTIFICATE MIIINRFR- PW%/IQlnu ul 1"Mr-0. 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. INSR L TYPE OF INSURANCE ADDL S SR POLICY EFF POLCYNUMSER MMIDDIYYYY POLICY E0 MMIDDIYY LIMITS COMMERCIAL GENERAL LIABILITY CLACMS-0i1AOE ® OCCUR i 34-GL-2442-1 I 05/2512016 061251201$ (EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE PREMISES Ea occurrence _ , S 300,000 MED EXP (Any ono person) $ 5,0()0 �OF'LAG GREGATELIMIT APPLIES PER' s POLICY ❑ JJEC El LOG I OTHER: PERSONAL& ADV INJURY $ 1,000,000 GENERAL AGGREGATE s 3,000,000 PRODUCTS -COMPIOPAGG $ 1,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNEAUTOS SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINEO SINGLE LIMIT Ea acciden! s BODILY INJURY (Per ptr=A) s BODILY INJURY Per accident ( ) s PROPERTY DAMAGE I P r accldant $ S UMBRELLA LIAR OCCUR EXCESS LIAR CLAIMS -MADE i EACH OCCURfENCE AGGREGATE j $ $ DED RETENTION $ S WORKERS COMPENSATION AND EMPLOYERS. UABILITY YIN ANY PROPRIETORMARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? Li ,(Mandatory in NH) 11 yes, describe Under DESCRIPTION OF OPERATIONS below NIA PER 0714 STATuTE.1 I.ER E.L. EACH ACCIDENT $ E.L, DISEASE -EA EMPLOYE ---•— $ E.L. DISEASE -POLICY LIMIT $ i I I l DESCRIPTION OF OPERATIONS I LOCATIONS / V9HICLE5 (ACORD 191, Additional Remarks Schedule, maybe attached temom apace Is required) not for profit community service organization 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZE"— EP NTATIVE 4�1 X ©1988-201 CORD CORPORATION. All rights reserved. ACORD 26 (2016103) The ACORD name and logo are registered marks o ORD 100MG6 132849,12 03-16-2016