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NIEZPLU-01 _... ._...�.. <br />�� � CERTIFICATE DATE (MMIDDIYYYY) <br />ICATE OF LIABILITY INSURANCE 812012019 <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 olic ies HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED the must have AD............._�...........__...d.. <br />_..._.__...__........... _....... _._ p Y( )..........................DITIONAL 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 />Dan Berry Insurance Agency Inc. <br />54101 Ironwood Road <br />South Bend, IN 46637 <br />255-6222 <br />254-2630 <br />----.._ ._.. .... _.... -- <br />INSURER A : West Bend Mutual Insurance Co 153,,,, , <br />--------- 5 <br />INSURED <br />INSURERµ8 ,.FirstCom „-Insurance Com ,man <br />P P ... .... _ ..__.. <br />276, <br />Niezgodski Plumbing, Inc. <br />InIsuRFltc_ ....,. <br />PO Box 3096 <br />INSURER D : <br />South Bend, IN 46619 <br />......, <br />.�. <br />INSURER F : <br />I�E�"IFI�G�1TmNUMBER: REVISION"(."OVERAC_....� �.._ m m I(!(tlMI3ER: <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, <br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. <br />LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />m _ <br />ADDL SUBR <br />IAaR. TYPE OF INSURANCE .� ... <br />A� ICY EFF JL POLICY EXP <br />POLICY NUMBER LIMITS <br />__.... <br />A X COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />00 <br />1,000,000 <br />CLAIMS -MADE I X OCCUR <br />D <br />A495062 8/21/2019 8/21/2020 DAMAGE 0 RENTED <br />300,000 <br />_ <br />.MEDEIAnyP( Xonepperso0 <br />5,000 <br />PER,SQNAL &wADV INJU,F2Y <br />1,000,000 <br />GEN L AGGREGATE LIMIT APPLIES PER: <br />GENFRAL_AGGI�EGATE $. <br />2,000,000 <br />POLICY Loc <br />PRODUCTS COMPIOPAGG $ <br />,W.m..,... <br />2,000,000 <br />OTHEW <br />$ <br />COMBINED SINGLE LIMIT <br />1,000,000 <br />AUTOMOBILE LIABILITY <br />CLA AWOM - ., ......... <br />X ANYAUTO <br />A495062 8/21/2019 8/21/2020 BODILY INJURY (Perperson) <br />OWNED 1 SCHEDULED <br />AUTODS ONLY AUTOS <br />BRORD�LY INJURY (Per accadent) $ <br />HIRED <br />ONLY _,I A8%T %NaI�i. <br />„(Pate ms r DAMAGE <br />_ A � ....._C.....�. . _._ <br />UMBRELLA LUIB OCCUR <br />._.....__. ..................._...� a-_..._ �. <br />EACH OCCURRENCE,,, <br />2,000,00p <br />EXCESS LIAB CLAIMS -MADE <br />A495062 8/21/2019 8/2112020 ATE <br />AGGREGATE $ <br />DED RETENTION $_. <br />_� <br />� ..... .. i ..,.... - $ <br />2,000,0001 <br />..._ <br />"' <br />B WOR ERS COMPENSATION <br />.-....... <br />PER <br />ID I RH <br />AND EMPLOYERS' LIABILITY <br />YIN <br />C0190699-01 812112019 8/2112020 <br />n <br />SOO,000 <br />O PARTNER/EXECUTIVE <br />t ExcLUDED� N / A <br />ANaPRO <br />E L EACH ACCIDENT $ <br />iC RIMI,MgER <br />do <br />DISEASE EA EMPLOYEE $ ,,.. <br />500,000 <br />. <br />If yes, devAbe under <br />DESCRIPTtON OF OPERATIONS below ......_.IT,�„ <br />..._ _ <br />.........„„„_.... „„„.. �_....... _...... E,L DISEASELIME- - POLICY ' A_,,, <br />0�'()00.. <br />e attached if more space Is required) <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be <br />_ ..._... _.__.... .._._.. _ ..._._ .. _ _ .......-..-- <br />......... ....... _ <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, <br />City of South Bend ACCORDANCE WITH THE POLICY PROVISIONS. NOTICE WILL BE DELIVERED IN <br />227 W. Jefferson Blvd. <br />South Bend, IN 46601-1830 - - __.......-� ��-- <br />AUTHORIZED REPRESENTATIVE <br />................... ---- —_.----,___-,-,_................-.... <br />ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />