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DATE (MM/Y) CERTIFICATE OF LIABILITY INSURANCE 01118/20242024 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 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If 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 CONTACT RAY BARSON NAME: McGowan Insurance Group PHONE FAX PHONE Yt - AIC, No PO Box 6458 EMAIL rayb@mcgowaninsgrp.com ADDRESS- INSURER(S) AFFORDING COVERAGE NAIC # South Bend IN 46660 INSURERA: Frankenmuth Insurance Company 13986 INSURED INSURER B - LaSalle Hospitality Group, Inc INSURER C LaSalle Properties LLC INSURER D 115 W Colfax Ave INSURER E : South Bend IN 46601-1601 INSURER F: rnVGvnr_cc r=0TlGlreTF NIIIIIIRFR• CL2411864058 RFVlc;fnN NIIMRFR- 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. ILTRR TYPE OF INSURANCE ADDL INSD = POLICY NUMBER POLICY EFF IMMIDDNYYY POLICY EXP MMIDONYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMA13E1UR1zN1tU PREMISES Ea a=rrence $ 750,000 X MED EXP (Any one person) $ 10,000 Primary Non Contrbutory (PNC) X Waiver of Subrogation (WOS) PERSONAL &ADV INJURY $ 1,000,000 A Y 6710933 01/01/2024 01/01/2025 GEN'LAGGREGATE LIMIT APPLIESPER : GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 POLICY ❑X PRO•JECT LOC $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accdent $ 1,000,000 BODILY INJURY (Per person) $ ANYAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY 6710932 01/01/2024 01/01/2025 INJURY (Per accident) $ 4AMAGE t $ X EAGGREGATE $ PNC X WOS X UMBRELLA LIAB X OCCUR URRENCE $ 3,000,000 A EXCESS LIAB CLAIMS -MADE 6710933 01/01/2024 01/01/2025 $ 3,000,000 DED I X RETENTION $ 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A 6710931 01/01/2024 01/01/2025 X1 STATUTE I I EERRH EL EACH ACCIDENT $ 500,000 E L. DISEASE- EA EMPLOYEE $ 500,000 E.L DISEASE - POLICY LIMIT $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below Limit $1, 000, 000 A Liquor Liability 6710933 01/01/2024 01/01/2025 Aggregate Limit $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) City of South Bend -Board of Public Works is Additional Insured to the general liability when required by written contractlagreement 30-Day Notice of Cancellaiton applies EXCEPT for Non -Payment of Premium. L:tlKIII-iLAIt HULUtrt I.AI4L.CLLA1IUn SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BF, CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend Board of Public Works ACCORDANCE WITH THE POLICY PROVISIONS. 1316 County -City Building AUTHORIZED REPRESENTATIVE 227 W. Jefferson Blvd South Bend IN 46601-1830 jr(� @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD