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AC oe CERTIFICATE OF LIABILITY INSURANCE GATE (MM DDMYY) 12/5/2023 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 01 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 WANED, 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 Arthur J. Gallagher Risk Management Services, LLC 9155 South Dadeland Boulevard, Suite 1112 Miami FL 33156 NAME: Mabel Beltran PHONE FAX - 786-331-1267 ,: Ef4AIL _ mabel beltran a' .com INSURERS AFFORDING COVERAGE NAIL$ INSURER A: Philadelphia Indemnity Insurance Company_18058 INSURED FOUREPI-03 INSURER B: Technology Insurance Company Inc 42376 Fourth Episcopal District AME Church Olivet AME Church INSURERC: INSURER D: 719 N. Notre Dame Ave. INSURER E South Bend IN 46617- INSURER F COVERAGES CERTIFICATE NUMBER: 1975989730 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. INSIR TYPE OF INSURANCE AOOL im USR POUCYNUMBER POLICY OFF POLICY EX Rk%UDQffWi, LIMITS A X COMMERCIAL GENERAL UABUJTY PHPK2629079 12/1Y2023 12/1/2024 EACH OCCURRENCE $1,000,000 CI -AIMS -MADE rx] OCCUR PREMISESEe occurrence $100,000 MED EXP (Any one peel $ 5,000 PERSONAL B ADV INJURY $1.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000.000 POLICY JET FX LOC PRODUCTS-COMP/OPAGG $3,000.000 X I sexual Ma(XndUC1 $1,000,000 OTHER: Par Member AUTOMOBILE LIABILITY PHPK2629079 12h/2023 12/1/2024 COMBINED SINGLE LIMIT Ea awdeml $1,000,000 BODILY INJURY (Per Parson) $ ANY AUTO OWNED X SCHEDULED AUTOS ONLY AUTO $ BODILY INJURY (Per ectldent) E PROPERTY DAMAGE Per 'dart $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY A UMBRELLA LIAR X OCCUR PHUBS91064 12/12023 12/1/2024 EACH OCCURRENCE $1,000,000 X AGGREGATE $1,000,000 EXCESS LIAR CLMMS-MADE DED RETENTION$ $ B WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN KWC1339064 12/1/2023 12/1/2024 X STAME ER E.L. EACH ACCIDENT $1,000,000 ANYPROPRIETORIPARTNERIEXECUTNE R/M OFFICEEMBEREXCLUOED9 ❑ NIA E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory In NH) _ If yes, describe under DESCRIPTION OF OPERATIONS beloe :r^ E.L. DISEASE -POLICY LIMIT $1,000,000 A O&O and EPL PHSD1941376 12/1/2023 12/1/2024 Omasmnce $1,000,000 Aeepeeeae Urns $2,000,000 R tteenntltl D80$7,500/EPLI$15 K DESCRIPTION OF OPERATIONS I LOCATxINS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe atechad N more span is required) Automobile coverage applicable to members with scheduled automobiles on file with company. All affiliated members receive Hired and Non -Owned Autos coverage. Claims Made coverage for D&O. EBL and EPL. Retro Date: 12/112014 Sexual Misconduct Liability is excluded in the Excess Liability policy. Evidence of Insurance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Olivet AME Church ACCORDANCE WITH THE POLICY PROVISIONS. ' 719 N. Notre Dame Ave. South Bend IN 46617 AUn10RMEOREPRESENTATNE USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD