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%-^M A--ff DA -M (MMfDDNYYY) <br />k.1-1, CERTIFICATE OF LIABILITY INSURANCE 10/15.COIS <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, E)ffEND 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(ios) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain polides may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorse mants ). <br />PRODUCER CONTACT <br />NAME: Matt Dodd <br />Pilot Insurance Agency A/C No East : (574) 855-4937 <br />822 W. 8th St. -A C, No <br />INSURER(S) AFFORDING COVERAGE <br />NAIC 0 <br />Mishawaka IN 46544 <br />INSURER A; Indiana Fanners Mutual Insurance Company <br />INSURED <br />INSURERS; <br />Grove Excavating <br />INSURER C <br />30495-6 County Road 24 <br />INSURER D.- <br />JINSURER <br />Osceola IN 46561 <br />INSURER F: <br />Ci;VERAGES CERTIFICATE NUMBER: <br />_ REVISION NUMBER: <br />THIS IS TO 3M-nFY THAT THE POLICIES OF INSURANCE LISTED SEEM 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 />MW <br />WOM SURR <br />F TYPE 01: INSURANCE <br />LTR INSD WVO POLICY NUMBER <br />-MaLly <br />mum 1001100 LIMITS <br />_f <br />X'COMMERVAL GENERAL LIABILITY <br />--::ICLAIMS-MADE Fx-]OCCUR <br />EACH OCCURRENCE $ <br />J7)J3Q0V6 "RMTMU <br />11000,000 <br />PRtMEES !MCrE—) <br />100,000 <br />M!EO EXP (AAY one VIII—) $ <br />5,000 <br />A I CGLI008928 <br />06/08/2018 06/08/2019 prRSONAL & ADV INJURY $ <br />110001000 <br />GENT AGGREGATE LIMIT APPLIES PER: <br />X POLICY OPRO' <br />JECT LOC <br />F-] <br />-- <br />CEN&RAL AGGREGATE S <br />2,000,000 <br />PRODUCTS - COMPIOP AGG $ <br />2,000,000 <br />OTHER: <br />—Ty <br />.AUTOMOBILE T FA a i u <br />- — - ........ — ............ <br />T <br />ANYALITO <br />(Ea atd�� <br />1,000,000 <br />— <br />BOOLY INJURY (Per person) $ <br />OWNED <br />OWNED SCHEDULED <br />A S6HCD'JLCO <br />U' rOS ONLY X AUTOS <br />— AUTOS ONLY X AUTOS CAPI009680 <br />05/23/2018 05/23/2019 BODILY INJURY (Pot accicenl) $ <br />HIRED NON -OWNED <br />HE "ON -OWNED <br />ONLY <br />AUtCG ONLY AUTOS ONLY <br />S AUTOS ONLY <br />VM­aRi­UA'UUA8- OCCUR <br />CUR <br />U r <br />rAcI-f OCCURRENCE I$ <br />'SS U <br />EXCESS; LIAB CLAIMS -MADE <br />CLAIMS MADE <br />. .... ... . . <br />AGGREGATE $ <br />DED RETENTION !i <br />ORX Ratolel.Ebl' T"W <br />XERS COMPENSATION <br />kNO EMPLOYERS' LIABILMY YIN <br />WY PROPRIETORMARTNER(EXECU71VE <br />)FFICF-FUMEMBE'R EXCL6DED"? N/A <br />. <br />EL. EACH ACCIDENT $ <br />......... <br />Mantlailory in NH) <br />I describe under <br />E.L. DISEASE. - EA EMPLOYEE $ <br />rs,r <br />.S RIPTION OF OPERATIONS below <br />' . . ....... . <br />.. <br />EL. DISEASE - POLICY LIMIT $ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached IF more space Is required) <br />I'r-RTIr1(*.ATI: Wfil n=0 <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 POUCY PROVISIONS. <br />AUTHOKRIUD REPRESENTATIVE <br />@ 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />