|
CANNWAT-01 _ ___K_Q_WaHR
<br />DATE (MM/DD/YYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE 6/10/201_9
<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(les) 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 />1st Source Insurance Inc. PHONE CY j seer
<br />mm. - ., .......
<br />' 271-5200 Nlf 574 271 �240
<br />Kris B�
<br />6909 Grapa Road nip ENy j574 — _ ......v._ ...
<br />Mishawaka, IN 46545 0 '6;. �_ ... urce..om
<br />i»rlossfarlf lsteol.Nrce c.... � ....... _ ...... --
<br />.-9NoEiBtS1, AFFRGIp C la. ......... Apc a .n_. .. � 1390_—....
<br />......�.�.. INSURER B : ll'( Mtrtl�) �rl'$tl t"aN"fCY@` i9 NTl�larti ., Iwl'
<br />kNS41N,R.,A ral7erlf'rp
<br />INSURED
<br />Canney's Water Solutions, Inc INSURER C
<br />._ __..._ ..... ............
<br />1205 Mishawaka Ave INSURER D :
<br />South Bend, IN 46615 .._._._ ..... - .. _. ..... ........
<br />INSURER E
<br />INSURER F :
<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 />NNSEXCLUSIONS AND CONDITIONS_ BY PAID CLAMS.
<br />OF SUCH POLICY NUM ERVE BEEN REDUCED F I _ , -- LIMIT
<br />RANCE Na�wDL sNa* LIMITS SHOWN MAY s .� _.. POLICIES, �.._ POLzcir P
<br />_.. GENERAL LIABILITY POLNCY EF 1,000,000
<br />TYPE OF INSU
<br />A X COMMERCIAL GENE EACH CCCURRENI E
<br />CLAIMS -MADE X OCCUR 660031 7/20/2018 7120/2019 DA,O 5tI0,000
<br />.. �..........� 1P.,PAM3 RENTEC'
<br />�SI+S, IF-Gh5"&;4dTi5t�.l. .. �.m............... ,___v_-....
<br />........ .. _ME Ex? Aryjma.partobyµ .......— 5000
<br />X N'L AGGREGATE- PIMITAPP ES PER. {,EP7Lf A GNsI FRadkTE Vim_.. ,,,...... 2,000,006
<br />l'.... � JIRCOT ...,. Oc 2,0110 000
<br />R'OC)C7hJCTS��MP/�7&�Aia,.._.�. "
<br />OTi'-iE.R:
<br />A AUTO MOBILE LIABILITY COMBINEDSIIt',1GLELIMIT � 1
<br />8 DIL .1 l l ",.,,
<br />000 000
<br />X ANY AUTO 6601030 7/20/2018 7/20/2019 BGILY aNyUtY PNnr _.rsP I
<br />OWNED ..._.... SCHEDULED
<br />AUTOS ONLY AUTOS
<br />AUTOS ONLY �yt & OP# RT d �LMAGE
<br />HIRE At➢'6�7�NLY PY�Rcarae<Ideat ...
<br />A X UMBRELLA LIAR X OCCUR DI"i ggq,1dFj91gN .m ... 2,000,000
<br />DED X RETENTI S MAOE 6601031 7/20/2018 7/20/2019 2"0
<br />EXCESS LIAR V1 AG�roREGAT �_�, 00,000
<br />,..._. _, ,
<br />ON S I�
<br />A I WORKERS
<br />ORKERS COMPENSATION
<br />OM A T
<br />EL N.71SR
<br />29 X.P1TF67i1-
<br />ANY PROPRIETOR]A70AND EPLOYERS'LIAaILIM Y PN
<br />IRL,680107120/2019
<br />fFFnNCE"m m�
<br />600,000
<br />000JL7 m
<br />n - — 0000
<br />d63fdnGFI ALJMPI{IP 511 .. .. -
<br />O$EASEPQI YIMNN S
<br />600,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
<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 />501 W. South St. ACCORDANCE WITH THE POLICY PROVISIONS.
<br />South Bend, IN 46601
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|