Special Event - Riley High School Homecoming Parade - October 6

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ACCO 0® CERTIFICATE OF LIABILITY INSURANCE TE DA 1(io/zoz THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED EPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. PORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(iss) must have ADDITIONAL INSURED provisions or be endorsed. it SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Gibson Insurance Agency Inc 202 South Michigan St., Suite 1400 Bend IN 46601 CONTACT NAME: Felicia Adamson PHONE 574-245 9949 jd�c No;574-236 6399 IAIC,South A DRESS: fadamson th ibsoned e.com INSURERS AFFORDING COVERAGE NAIC# INSURER A: Midwest Employers Casualty Company 23612 INSURED SOUTBEN-04 INSURERB: Liberty Mutual Middle Markets South Bend Community School Corporation 215 S Dr. Martin Luther King Jr. Blvd INSURER C: South Bend IN 46601 INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER:509775930 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POUCYNUMBER MM%DDYEFF POUDYEXP UNITS B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE rx] OCCUR TBCZ51294136041 1211/2022 1211/2023 EACHOCCURRENCE $1,000,000 IJAMINQETORENTIU PREMISES Ea ocwnenoe $5001000 MED EXP (Any one person) $15,000 PERSONAL& ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY E JECOT LOC OTHER: GENERAL AGGREGATE 52,000,000 PRODUCTS-COMP/OP AGO $2,000,000 Employee Benefits $1,000,000 AUTOMOBILELIABLIT' X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY AS6Z51294136011 12/1/2022 1211/2023 COMBINED SINGLE LIMIT Ea accident $1.000.000 BODILY INJURY (Per parson) $ BODILY INJURY (Par accident) $ PROPERTYDAMAGE Per accident $ GarageKeepen, $30,000 8 X UMBRELLA LIAR EXCESS LIMB X OCCUR CLAIMS -MADE TH7-Z51-294136-051 12JI12022 12/1/2023 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000.000 DED I X I RETENTIONS in nm $ A ! WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTNE YIN OFFICERIMEMBEREXCLUDEDT (Mandatory in NH) Use, describe under DESCRIPTION OF OPERATIONS below NIA EWC009940 7F7/2023 7/7/2024 STATUTE ERµ E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE S1,000,000 E.L. DISEASE -POLICY LIMIT $1000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached N more space Is required) Re: Riley's Homecoming Parade 10-6-23 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The City of South Bend 227 W. Jefferson St. ® South Bend IN 46601 AUTHORIZED REPRESENTATIVE &Y'Scin 3�ilJ7l%t1%rc L r;CIlG 7 01988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD