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STMARGA-01 LeA
<br />-» DATE (MMIDDIYYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />1 1 r2/rt1 lt
<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 />..... .._W .....
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 />The Healy Group„ Inc.
<br />17535 Generations Drive
<br />South Bend, IN 46635
<br />741271-6000
<br />243-3214
<br />INSURERA:SelectI've In surance Group Inc ......... ......... .... 112572
<br />INSURED
<br />St Margaret's House Inc !NSURERc;
<br />117 N. LaFayette Blvd. INSURER D
<br />South Bend, IN 46601
<br />INSURER. E
<br />INSURER F
<br />.......... ..... ...... ...... ._.ITIT m _..._._._._
<br />COVERAGES ... __ ...._..._.. _C C I � I�IUIMB_ R-. _.- REVISION NUMBER: ._.�._
<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 />TYPE OF INSURANCE POLICY
<br />INNSR AM_....._._,....__.._._.. ___ 'ADDbfSUBR'
<br />1 NUMBER f POLICY EFF POLICY EXP LIMITS
<br />.�A�t/R0�..1�1M(N�RLYXxyt. I
<br />A X COMMERCIAL GENERAL LIABILITY 1,000,000
<br />�. CLAIMS -MADE � X� X DAMAGE
<br />e _ :$ .1,
<br />EACH OCCURRENCE
<br />OCCUR $ 2238806 08/0112018 08/01/2019 ERENTED - 20,000
<br />MED EXP ,Any oneperspnl ! $
<br />1,000 000
<br />PERSONAL "&,ADV INJURY 1$ 1,000,000
<br />E,N°d AGGREGATE L APPLIES PER ,GENERAL AGGREGATE
<br />$ 3,000 000
<br />POLICY %e LOC PRODUCTS COMPIOPAOG $ 000,000
<br />,��aDThIE'...... ..............._---........_...........__WWW__W_._ g
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />ANY AUTO BODILY INJURY (Per person) $
<br />�w
<br />OWNED SCHEDULED -
<br />A RFbD NO,�-tJN P OPER rY� RY (Par accident) $ .
<br />AUTOS ONLY AUTOS BODILY INJURY
<br />DAMAGE
<br />!JT S ONLY A O ' O d QEeR arrldpn, i ,,,,,,,, ,, $
<br />__-. . . ._.................. ... -
<br />A X UMBRELLA LIAR 1l OCCUR I . EACH C RRENCE $ 1,000,000
<br />EXCESS LIAB CLAIMS -MADE X S 2238806 08I01/2018 08/01/2019 1 000 000 CU
<br />DED f RETENTION $ $
<br />WORKERS COMPENSATION PER OTH-
<br />AND EMPLOYERS' LIABILITY Y I N �,,,,,,, H STATUTE. � , """"""� ER
<br />IETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT
<br />ANY PROPRI
<br />rpN°FRRUI MBER EXCLUDED? �IN I F` E.L DISEASE - EA EMPLOYEE $
<br />Jftaaudatory�n NH) a- ..
<br />If yes, describe under,
<br />OESGRIPTI0 OF OPERATIONS below € E.L. DISEASE -POLICY LIMIT
<br />, 1
<br />D of South Bend is IONS I LOCATIONS
<br />N 9I VEHICLES
<br />Insured
<br />_... (ACORD ..... ___........_.u._ ......uu
<br />DESCRIPTION OF OPERATIONS I LOCATNONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />City
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of South Bend THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />125 S. Lafayette Blvd
<br />Suite 100 ._................ ._ _..... .......
<br />.. ..
<br />South Bend, IN 46601 AUTHORIZED REPRESENTATIVE
<br />_ _._..__..............................w...........�....—......... ........... _........ _._ _..............
<br />ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
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