Laserfiche WebLink
z F DATE (MMIODIYYYYJ <br />CERTIFICATE OF LIABILITY INSURANCE <br />1 04/11/2019 <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 />-irpo—F-W-N-Tif the certificate tioldWr--Ii-a-n—A6'Di—nO—N—AL—IN—'S'-U—RED—, ,the p—olicy(les) im--ust-h—ava-A-DDITI AL 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 />rA <br />PRODUCER C'ONP C' Michelle Harrell <br />HAM;- ... . . .. . ... ... . ..... . ....... . ...... . . ... <br />PHONE (5 4)674-0015 tA, X-,- (574)674-9582, <br />Randy Leliaert Agency Inc [JAW, Npj:l <br />MAIL <br />410 Lincoln Way W AF-nDRESS_ shelly@realvaluems.con) <br />tkSURERlIS),AFFORDING COVERAGE NAIC A <br />OSCP-69 1 N 46561 INSURERA: Minois CasuNty Company 000000 <br />INSURED INSURER 11311. <br />Vegetable Buddies Inc INSURER C <br />............................. . . ..... -1-11 <br />130 Box 1202 INSURER D' <br />South Bend IN 46624 <br />COVERAGES CERTIFICATE NUMBER: 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 />INER �AODL 8LMAJ PO 6(J'0Y'rXP . ........ . .......... <br />TYPE OF INSURANCE imqn wvn POLICY NUMBER MROONYYY) —1 _ LIMITS <br />1 yyy <br />X COMMERCIAL GENERAL LIABILITY 11.:ACH 0GOIJIRRIENCE $ 1000000 <br />(;I-AlhYS-NIAIDE IXIOccUag100000 <br />FXPd,Aivy ono person) $ 2000 <br />A Y N IN:138698 0412812019 0412812020 IIUIRSONAA ADD FILMVY s 1000000 <br />$ 2000000 <br />(,HNI AGGRFGA1[E:1AMH AP1111111-5114 R <br />Ro 11�lffl F F PRODUGI S - GOMP/OVAGG POHCY ..0G $ 2000000 <br />i)-UY1J—C----....-..- ... ........ . ... . ....... --J T ffWT1 1714 � —APGTT�71 F�� r- <br />AUTOMOBILIABILITY <br />P&W LE ALI TO BOD111 Y ftJURY (Pail persmi) $ <br />OVAffiff D SCHI- DUILED BOOH-Y 11JUI6iY (Per accdeN) $ <br />M.HOSONII.N AU10S <br />11IRED I:q N (mm,ff 11) . .... ... ........... .. .. .. . ...... .. ....... . ........ . ......... . ..... <br />A[P� 0,.1 ONLY AWDSONY I i <br />- - -- - ----- — .. .. . .............. ........ <br />AJ�<UMBRE <br />LLA LIAB S LIAB N N UL15936ITIT 04/2512019 04125/2020 A(36REGAII C-- $ 1000000 <br />... . .. .... <br />sore o-awlrhlilll;�lts$ <br />10000 $ <br />. ........ . - — ------ - - <br />WORKERS COMPENSATlON PIER W �1 <br />im . .. . ..... ....... . ....... <br />AND EMPLOYERS1 TAn".FTY YIN " � AU, I , <br />ANY PROPRff u�AGHAGQIIDLN$ 100000 <br />A 0H RA11 ARER a XCI UOH)7 N/A N WC16896 04/25/2019, 04125/2020, <br />mandatory an NH) L WS'aASF EAa-NIM $" 1'66666 .............. ...... . <br />I W: �i, d�VU(bo widor <br />D� SCR PTION OF OPFRAJ bONS lwkm I - D'lSl. ASF - PW. WY [$ 500000 <br />Each Common Cause B` 1000000 <br />A Liquor Liability N LL101147 04/2512019 04/25/2020 <br />. ............... <br />DESCRIPTION OFOPERATlONSILOCATIONS IVEMCLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space In required) <br />City of South Bend is additional insured in regards to sidewalk cafe' operations <br />CERTIFICATE HOLDER CANCELLATION <br />MAMUXZ� <br />6- <br />r4lxilli r4 7 MM1-1=1 pro I <br />.1 - 1 -1 1 111Q <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED JJ <br />ACCORDANCE WITH THE POLICY P9QMWMVS. <br />AUTHORIZED REPRESENTATIVE <br />0, <br />ax: Email: 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />