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,m CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br />0412212020
<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(fes) 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 stick endorsernen s .
<br />PRODUCER CON101111' Steve McNeil
<br />NAME.
<br />Aldridge Insurance
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<br />1323 North Ironwood _
<br />,___....INSURE R(S) Ar FORViNG COVERAGE NAIC #
<br />South Bend IN 46615 INSURERA Erie Insurance IfNan� 26271
<br />INSURED INSURER B .
<br />Woochi Japanese Fusion & Bar, Inc. INSURER c
<br />119 N Michigan Street INSURERD
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<br />INSURER E
<br />South Bend IN 46601 INSURERF .
<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 />.... ........
<br />TYPE OF INSURANCE a6� POLICY E F POLICY FJCP .
<br />L1R.._.. �,... .....,F..PQLNCV MBER ((i@ p,I�X.I' .._..... LIMITS..._. .m...�...
<br />COMMERCIAL GENERAL LIABILITY
<br />a r l� ? r mrP 100000.0 _
<br />EACH OCCURRENCE$ 1
<br />rI...IeNr,dSMANE 1__ I rncCNara 000000
<br />-e,�by $ 5000
<br />,...... .It1LNi6 I afl7 fiAi�� edPi� g-�._.,..e..e
<br />A I — Y
<br />Q97-1154951 11/02/2018 11/02/2019 1:1_R ONA &ACV INJURY $ 1000000
<br />GENT N,N"L AG GRIIyG ATu- LNNwYnr Ar I nI llES PER.- c I INI IxFat Ar.,s IdN a ATIr $ 2000000
<br />POLICY I ... .� ��N.rf LOG I�Yxzf�el�Cr",;� - C0MII ,0P Acrs $ 2000000 __
<br />arequFr:.
<br />Contents Llabilit 141.500
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<br />AUTOMOBILE LIABILITY COMIANIA, ,IP1, Ti N.gFp .�
<br />ANYAUTO IF.NCSIII..Y NJL.HkY (Per persou) $
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<br />ALII gill
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<br />UTOS ir#ILYNNaRV(Nara.r<krul) $
<br />NItEeA.a. nNI:
<br />$
<br />_............. $
<br />UMBRELLA LIABOCCUR EA I 1fURR fC $
<br />CEXCESS LIABLANMACEA.LIdll A .i
<br />.._._....,
<br />WORKERS COPENSATION PER ,'
<br />_
<br />AND EMPLOYER S'LIABILITY STAII¶4C"_
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<br />ANY PROPRIETOPIPARTNEWEXECUTIVE `" '" F.1 AN HACt DE N41( $ 100 000
<br />A OFFICERlMEMBEREXCLU EIp�7 Y N/A Q94-0900651 10/09/2018 10/09/2019 -- -• ..�
<br />(NNlandatoryIn NH L ere ALA EA I Nall IJZYI r� $ 500,000
<br />111yes, dos¢xffie under_._ . ...
<br />#R �CIUWTIONOF OPLfl.A:l`IONS lre!lovvI E L Nr•'NSI-AEI.::. PI.7LVF;Y LOTvreFlf . $ 100,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />The city of South Bend is listed as an additonal insured regarding the Sidewalk cafe operations. A 30 day notice of cancellation is in effect.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of South Bend SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Board of Public Works THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />227 W. Jefferson Blvd. ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />South Bend
<br />Fax: mail: © 1988-2014ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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