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ATE <br />IUC <br />AC�ORIO CERTIFICATE OF LIABILITY INSURANCE 07112 zo 31255r' <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 POI ICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(B), AUTHO IIZED <br />REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER <br />IMPORTANT: If tho corli icater holder Is an ADDITIONAL INSURED, the Pollcylioal must have ADDITIONAL INSURED provisions or be end rsed. <br />N SUBROGATION IS WAIVED, subject Do the terms and conditions of the policy, certain policies may require an endorsement A statement on <br />Ibis ceRifioats doss not confer lights to the certificate holder in lieu of such andorssmard al. <br />PRODUCER <br />"ME <br />Hartlesty, Blake H.r.. .15741223-2100 - - — - --iP <br />230 E 9th St Blake.Hardesty@infarmbumau.cam <br />Rochester. IN 46975 ADOAEac. _ <br />wWtFRA: United Farm Family Mutual lnsuranco Company 152 <br />WARRED <br />IN6UREN6: <br />FARMERS MARKET INC <br />- --'------ --- <br />INRI.RFi55:__ _.'----_----- <br />'-- <br />.__--- <br />I105NORTHSIDEBLVD <br />SOUTH SEND, IN 46615-2926 <br />wwRERP. <br />_ <br />lwwk a-- <br />IN6URERF: <br />COVERAGES CERTIFICATE NIIMRFR- RFulglnu AllI"-FR• <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW MANE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY F <br />iRIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERIA OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WVHICI <br />I THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE <br />RMS, <br />EXCLUSIONS ANDCONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY CLAIMS. <br />_PAID <br />MR <br />LM IYPE OFwWRl1NCE _ jiBdC3tIBR,-- Z._ NUMAEA roWYEFFI yIICT EIJ ; �� <br />CONMEACIAt OEIrERALLUIBRITY <br />1 EACH OCCUNR6NCE a1.Qli <br />CUlM5-NODE X. 000LR . <br />.. <br />OgILL£T6FENTen— <br />PAEk16ESSEasLUPmwi_ rs100.00D— <br />- <br />-__ <br />MEDEXPIAnymevenewn <br />A <br />__. _ _ CPPB166918 D7/1912022 i07/19/2023 <br />PER6[Na.AADY nLSIRY fl.aey.DQq <br />__ <br />gFNEAAI AOORECATE a 2 <br />GCNLAOOREGATCUMTAPPLESPEA <br />I <br />POLICY EEC LOC <br />__._ __ <br />,OOD.000 <br />PRODUCTS- CONP.OPAGG_1 <br />I200.0,000 <br />: <br />ODE2 <br />AMFOMOeIELWIIrrY <br />GnMBI FPa NGLE 4NlT <br />�AMY ADTD <br />DOO LYNAWYiPerp �L1.DOD.000 <br />A <br />'AMOS X iw"�i1Ep j CPPB166918 07l19f2022 07/19f2023 <br />WLY ARi09 <br />1 <br />BODILY wXmrlPPracmPll!t <br />- <br />X <br />IFAUTOSI NED ! <br />Ws1E0 <br />RED <br />AUTOS ONLY JAUT090NLY <br />-----' <br />IpPE�RTYNDOMADE <br />It ' <br />X <br />IUNBME LAN IOCCUM: - <br />�EXCESsuA9 <br />EACHOCCURRENCE !6 <br />A <br />19/2022 '07119/202307/ <br />AawcrE s1.00,000 <br />MO ' RElEAITION00.000J--_— <br />WORNER6COMPENSATIeN <br />'AMU <br />pT <br />X yTATUTE <br />EMPLOYERS' LIABILITY WIN <br />- <br />RpeRTAEMCxECunY[ i <br />A <br />'07/1912023 <br />E.L. FACM ACCIDENT <br />WrPXNTALMI <br />DFFNZWTAE4BENEXLLUDf:D' .NIA WC 8336J52 p7/14R022 <br />Ixalwatary NNN7 <br />_ <br />EL DISEASE -EA EMPLOYEEI 65DLD00[ <br />11 ppaL. ObNb <br />t <br />04' O <br />DESCRIPngx pF OAEAA110Ng Lebn <br />El.OI6FiASE POLICY LIMIL I t SO0.000' <br />I <br />OEBCAIPnONOFOPEMTNmaI LDGmON6f YE19CI.a6 (AOIXIO tat, AaNXIPntlRM10Na acXPdla, mSp M Asacnra M mwe Space N rpNlrwl <br />RE: CAR SHOW ON 8-19-23 <br />CRY OF SOUTH BEND <br />227 W. JEFFERSON BLVD. <br />SOUTH BENO, W 46601 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES RE CAN <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE <br />ACCORDANCE WITHTIIEPOLICYPRO4ISIONS. <br />Hardesty, Blake <br />®1 OBB-2015 ACORD CORPORATION. All rights re <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />0 <br />IN <br />