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P ID:CH_ m_
<br />CERTIFICATE OF LIABILITY ISMSURACE DATE(MM/D°/YYYY)
<br />02/05/2019
<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(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />PRODUCER
<br />R.S. Mier &Sons, Inc.
<br />ll
<br />P.O. Box 229
<br />P U, CIC
<br />NAI`"Gregory,
<br />574 546-3341 ac N�; 574 546 2687
<br />—
<br />109 W. Plymouth Street
<br />y
<br />EMAIL
<br />ADDRES,S
<br />Gregory S. Miller, CPCU CIC
<br />9 ry
<br />PRoackiµTRUCK-1
<br />.R U ER _
<br />_ INSURER(SI AFFORDING COVERAGE NAIC #
<br />...... .u.....
<br />INSURED Trucks R Us, Inc.
<br />_.----- , ..._..
<br />INSURER A: West Bend Mutual Insurance 15350
<br />Lake Effect Excavating, Inc
<br />Lake Effect Snow Removal.........._
<br />INSURERB: ........................................
<br />Lake Effect Auto Sales
<br />INSURER C :
<br />23300 State Road 23
<br />iNsuRER D
<br />South Bend, IN 46614
<br />INSURERE: --------
<br />INSURER F :
<br />COVERAGES
<br />CERTIFICATE
<br />NUMBER:
<br />REVISION NUMBER:
<br />THIS
<br />IS TO CERTIFY THAT THE POLICIES
<br />OF INSURANCE
<br />LISTED BELOW HAVE BEEN
<br />ISSUED TO
<br />THE INSURED
<br />NAMED ABOVE FOR THE
<br />POLICY PERIOD
<br />INDICATED,
<br />NOTWITHSTANDING ANY REQUIREMENT,
<br />TERM OR CONDITION OF ANY
<br />CONTRACT
<br />OR OTHER DOCUMENT
<br />WITH RESPECT
<br />TO WHICH THIS
<br />CERTIFICATE
<br />MAY BE ISSUED OR MAY PERTAIN,
<br />THE
<br />INSURANCE AFFORDED BY
<br />THE POLICIES
<br />DESCRIBED
<br />HEREIN IS SUBJECT TO
<br />ALL THE TERMS,
<br />EXCLUSIONS
<br />AND CONDITIONS OF SUCH
<br />POLICIES.
<br />LIMITS SHOWN MAY HAVE BEEN REDUCED
<br />BY
<br />PAID CLAIMS.
<br />.�....,.,m...,..._.,..._.,....._....�.____._...._....._.�
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />SC/
<br />_..._........................._,_.-.
<br />POLICY NUMBER
<br />......
<br />POLICY EFF ....n.....
<br />MMIDDPYYYY'
<br />POmL�'C E1CP
<br />MWDD YYY
<br />�. .... ..
<br />LIMITS
<br />.................. ... .,�.
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,00
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />1�040137
<br />07/05/2018
<br />07/05/2019
<br />MT
<br />�R�FMIS ",� (�A �rurrLoo9r9J
<br />!--- _ ��*00
<br />CLAIMS -MADE X. OCC—U--R-
<br />MED one parson I
<br />$ 5,00
<br />PERSON?AL&ADV INJURY
<br />...._.....
<br />$ 1,000,00 .._. _
<br />_. --
<br />GENERALAGGREGATE
<br />$ 2,000,00_
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS- COMP/OP AGG
<br />'S w 2+0 0g00
<br />POLICY X PRO FI LOCIECI
<br />$
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />$ 1,0,00 00
<br />e„
<br />(Ea accident)
<br />(Ea accident)
<br />t)
<br />A
<br />X ANY AUTO
<br />A040137
<br />0710512018
<br />07/05/2019
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNED AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />SCHEDULED AUTOS
<br />�
<br />'
<br />(PROPERTY PER ACCIDENT)
<br />HIRED AUTOS
<br />NON -OWNED AUTOS
<br />-- --
<br />$
<br />UMBRELLA LIAR
<br />EACH OCCURRENCE
<br />.,—
<br />$ 2,000,000 _
<br />......_.0
<br />A
<br />1?!J10CCUR
<br />CV.AIMS MAD}
<br />__ EXCESS uA6 _
<br />A040137
<br />07/05/2018
<br />07/05/2019
<br />-AGGREGATE
<br />DEDUCTIBLE
<br />$
<br />X RETENTION $ 10,000
<br />X Lwc 57A I U• OTH=
<br />$
<br />WORKERS COMPENSATION
<br />t.I�i�M�lf!�9ii
<br />A
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERPEXECUTWE Y❑
<br />EXCLUDED
<br />N / A
<br />A040149
<br />071U5/2018
<br />07/05/2019
<br />E.L. EACH A4LtlDEN500,000_
<br />T
<br />.. _
<br />$ 50000..
<br />oFFICERIluIEMBER
<br />E L DISEASE EA E''MPLOYkF
<br />$ w
<br />(Mandatory in NH)
<br />If yas, describe render
<br />^^^ __.
<br />-POLICY LIMIT
<br />_ 500 a010
<br />A
<br />DC:Sk,RIPTIGJN or O
<br />Motor Truck Ca�Wnw
<br />A040137
<br />07/0512018
<br />07105/2019
<br />gASE
<br />MTCa r o
<br />100,00
<br />ded
<br />1 ,000
<br />DESCRIPTION
<br />OF OPERATIONS I LOCATIONS / VEHICLES
<br />(Attach
<br />ACORD 101, Additional Remarks Schedule,
<br />If more space is
<br />required)
<br />CITYSB1
<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 />City of South Bend
<br />Board of Public Works '.. AUTHORIZED REPRESENTATIVE
<br />227 W. Jefferson Ste. 1316 Gregory S. Miller, CPCU„CIC
<br />South Bend, IN 46634 r A. - t t 11�,
<br />©1y8-2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />
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