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ACOROCERTIFICATE OF LIABILITY INSURANCE <br />01YYYY) <br />nATE(M91I2018 <br />`,, <br />0611O <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). <br />PRODUCER <br />CONTACT Alison Christensen <br />NAME: <br />Gibson Insurance Agency, Inc. <br />PHONE Fxt, (800) 814-2122 aC No : (SDD) 836-2122 <br />130 S Main St, Ste 400 <br />AGDRESs: achristensen®gibsonins.Com <br />PO Box 11177 <br />INSURERS AFFORDING COVERAGE <br />NAIC p <br />South Bend IN 46601-0177 <br />INSURERA : Citlzens Ins Co of the Midwest <br />10395 <br />INSURED <br />INSURER B: Hanover Insurance Company <br />22292 <br />Studebaker National Museum <br />INSURERC: <br />201 Chapin St <br />INSURERD: <br />INSURER E ' <br />South Bend IN 46601 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 5/1118-19 Liab REVISION N11iVIRPRt <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />LTR <br />TYPE OF INSURANCE <br />AVULISUSK <br />POLICY NUMBER <br />DD CY EFF <br />MMI <br />POLICYP <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE � OCCUR <br />Z9WA166436 <br />05/01/2018 <br />05/01/2019 <br />EACH OCCURRENCE <br />1 000,000 <br />$ � <br />DAMAGE TO RENTE11- PREMISES Ea occurrence <br />$ 100,000 <br />MED EXP Any one Person <br />$ 10,000 <br />pERSONALBADVINJURY <br />$ 1,000,000 <br />GEN'LAGGREGATE LIMITAPPLIES PER: <br />POLICY ❑ jECOT- 7 LOC <br />OTHER: <br />GENERALAGGREGATE <br />$ 2,000,000 <br />PRODUCTS •COMPIOPAGO <br />$ 2,000,006 <br />$ <br />A <br />AUTOMOBILE LIABILITY <br />X ANYAUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED X NON-0WNEO <br />AUTOS ONLY AUTOS ONLY <br />AWWA165341 <br />05/01/2018 <br />0,910112019 <br />CO MBIND SINGLE LIMIT <br />Ea accl ent <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />Peracctdenl <br />$ <br />$ <br />B <br />X <br />UMBRELLALIAB <br />EXCESS LIAR <br />X <br />OCCUR <br />CLAIMS -MADE <br />UHWA166463 <br />05/01/2018 <br />05/01/2019 <br />EACH OCCURRENCE <br />$ 4,000,000 <br />AGGREGATE <br />$ 4,000,000 <br />DED RETENTION $ 0 <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN <br />OFFICERIMEMBER❑ EXCLUDED? <br />(Mandatory in NH) <br />If yes, describo under <br />DESCRIPTtONOFOPERATIONSbelow <br />NIA <br />WZWA165928 <br />05/01/2018 <br />05/01/2019 <br />X PERTUTE ORTH <br />ST <br />E.L.FACHACCIDENT <br />$ 500 000 <br />E.L. DISEASE -EA EMPLOYEE <br />$ 500,000 <br />E.L. DISEASE -POLICY LIMIT <br />$ 500,000 <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) <br />PROOF OF COVERAGE ONLY <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />1b19RR-2015 ACORD CORPORATION. All rinhhe raearvarl <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />