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10/26/2018 FRI 14!19 FAX <br />zoo9/oo9 <br />ENDORSEMENT <br />(TO BE ATTACHED TO CERTIFICATE) <br />Effective Dale of Endorsement: 12/112018 <br />Cancellation Date of Endorsement: 12/2/2019 <br />Certificate Holder: The Diocese of Fort Wayne -South 13end, Inc. <br />Chancery Office <br />P O Box 390 <br />Fort Wayne, IN 46801 <br />Location: ST JOSEPH CHURCH <br />216 N HILL ST <br />SOUTH BEND, IN 46617-0000 <br />Certificate No. 8679 of The Catholic Mutual Relief Society of America is amended as follows: <br />SECTION II -ADDITIONAL PROTECTED PERSON(S) <br />It Is understood and agreed that Section II - Liability (only with respect to Coverage D - General <br />Liability), Is amended to Include as an Additional Protected Person(s) members of the organizations shown <br />In the schedule, but only with respect to their liability for the Protected Person(s) activities or <br />activities they perform on behalf of the Protected Person(s). <br />It is further understood and agreed that coverage extended under this endorsement Is limited to and <br />applies only with respect to liability assumed by contract or agreement: and this extension of <br />coverage shall not enlarge the scope of coverage provided under this certificate or Increase the limit <br />of liability thereunder. Unless otherwise agreed by contract or agreement, coverage extended under <br />this endorsement to the Additional Protected Person(s) will not precede the effective date of this <br />certificate of coverage endorsement or extend beyond the cancellation date. <br />Schedule -ADDITIONAL PROTECTED PERSON(S) <br />City of South Bend,iN, 227 W Jefferson Blvd, South Band, IN 46601; <br />South Bend Venues Arts & Parks, 321 E Walter St, South Bend, IN <br />46614; Board of Park Commissioners, 321 E Walter St, South Bend, IN <br />46614 <br />Remarks (the following language supersedes any other language in this endorsement or the Certificate In <br />conflict with this language): <br />The City of South Bend and its respective elected officials, officers, employees, agents and <br />representatives; Board of Park Commissioners, and South Bend Venues Parks & Arts are named additional <br />protected person(s) but only for claims arising out of St. Joseph Church's St. Nick Six Race in the City of <br />South Bend on December I, 2018. <br />Autltori rRepreseutati e <br />PKS-122(10-11) <br />