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AC CPR" ffYYY <br />CERTIFICATE OF LIABILITY INSURANCE 2/21/2019 ) <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 pollcy(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 />certificate holder in lieu of such endorsement(s'). CON Mr <br />PRODUCER NAME _ <br />ROCKSTROH INSURANCE AGENCY INC PHONE ��(574) 232-2991 <br />333 N Lafayette Blvd[ADDRESs <br />C Na E.Xr C574 233-5136,N�, <br />Y rockagCY3 outlook . com <br />South Bend, IN 46601-1208 mm ITITIT <br />1 tlNS'ISRE.R(57p AFFORDING COVERAGE NAICN <br />I S RFR � Auto �i'iwfl'hBr3 Insurance <br />I <br />INSURED _South Bend Clnco LLC <br />�..�.... <br />� INSURER B <br />SBA Cinco <br />5NSURERC <br />709 S. Carlisle St. <br />__.- ........ <br />INSURER <br />South Bend IN 46619 <br />Sou <br />INSulat"R ETmmmmm,�, <br />INSURER F <br />W <br />COVERAGES CERTIFICATE NUMBER: <br />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 <br />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 <br />REDUCED BY PAID CLAIMS. <br />Lttt TYPE OF INSURANCE �� su fyyy f POLICY NUMBER <br />MMIDDIYYYY I MMlDD1YYW LIMITS <br />A� COMMERCIAL GENE LIABILITY 1 <br />f EACH OCCURRENCE $ <br />1 r 000 , 000 <br />XjA,C,E„T,�� <br />CLAIMS -MADE ' OCCUR <br />F P l ES a � an � $ <br />n m <br />50��00 1 <br />_.........1 <br />�.., <br />� ..W_ <br />MED EXP (Any one person) $ <br />10/16/2018 10/16/2019 .,_.-........ _ ..... <br />5 I <br />t 0 0 0 <br />RSONALBADVINJUR09150919 <br />$ <br />1,000,000 <br />AGGREGATE LIMIT APPLIES PER. <br />GENL A <br />,000 <br />000 <br />GENERAL AGGREGATE $ ! 2,000,000 <br />A i POLICY CI PRO. <br />JECT El LOC <br />PRODUCTS - COMP/OP AGG $ <br />G000 <br />OO <br />2 i r <br />7 0"N`I9ER: I I <br />' I $ <br />1 AUTOMOBILE LIABILITY <br />CUMPSINGLE, UMIT <br />a a IRS5tl, $ <br />BODILY INJURY (Per person) $ <br />ANYAUTO <br />ALLOWNED SCHEDULED <br />I INJURY (Per accidenaccident)$ <br />�AUTOSAUTOS JAUTOS <br />NON -OWNED <br />CEDl11A0 $ <br />HIRED __.' AUTOS <br />P amidonO _.. <br />UMBRELLA LIAB OCCUR <br />EACH OCCURRENCE $ <br />i EXCESS LIAR E <br />�.. CLAIMS -MAD <br />AGGREGATE Is <br />mmmmmm _....... <br />DED RETENTION $ <br />$ <br />PER 211-1- <br />� ER <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETRR/PPAARCTNEDIR/EXECUTIVE Yr ,N ` NIA 6, <br />C <br />1 E.,L, EACH ACCIDENT ..., .$ <br />..,. ...., ...... <br />(Mandatory in NH) � <br />E.L DISEASE - EA EMPLOYEF $ <br />if yes, dewbe under <br />DESCRIPTION OF OPERATIONS below <br />f E.L. DISEASE - POLICY LIMIT $ <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />;Additional Insured -City of South Bend <br />I <br />i <br />Board Of Public Works SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />1316 Count Cit Building THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />County -City g ACCORDANCE WITH THE POLICY PROVISIONS, <br />227 W. Jefferson Boulevard <br />South Bend, Indiana 46601 ptutma0 ALUI Kc,Vfcq>"IA0Ivt <br />©1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD <br />