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l 0 DATE (MMIDDIYYYY) <br />A.CpRo INSURANCE BINDER 09/20/2024 <br />THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON PAGE 2 OF THIS FORM. <br />AGENCY COMPANY BINDER # <br />JMS Insurance Inc. Auto -Owners Insurance Cos. 10012024Caf <br />300 Michigan Street JEFMCTPJF EXPIRATION <br />Walkerton, Indiana 46574 DATE TIME DATE TIME <br />(574) 586-7259 <br />CODE: _ I SUB CODE: <br />AGENOY S1210319162757223 <br />CUSTOMER IO: <br />INSURED AND MAILING ADDRESS <br />Mandeep "Lucky" Singh <br />6520 Lake Crest Circle <br />South Bend, IN 46628 <br />TYPE OF INSURANCE <br />PROPERTY CAUSES OF LOSS <br />BASIC L1 BROAD ❑SPEC <br />LIABILITY <br />dME R CI AL GE N E RAL LIABI LI TY <br />CLAIMS MADE ® OCCUR <br />RETRO DATE FOR C <br />VEHICLE LIABILITY <br />ANY AUTO <br />OWNED AUTOS ONLY <br />SCHEDULED AUTOS <br />HIRED AUTOS ONLY <br />NON -OWNED AUTOS ONLY <br />VEHICLE PHYSICAL DAMAGE DED ALLVEHICLES <br />COLLISION: <br />OTHER THAN COL _ <br />GARAGE LIABILITY <br />IANY AUTO — — — <br />EXCESS LIABILITY <br />_ UMBRELLA FORM <br />OTHER THAN UMBRELLA FORM RETRO DATE FOR <br />WORKER'S COMPENSATION <br />AND <br />EMPLOYER'S LIABILITY <br />SPECIAL <br />CONDITIONS <br />OTHER <br />COVERAGES <br />NAME & ADDRESS <br />City of South Bend <br />Dept. of Public Works <br />227 West Jefferson Blvd., <br />Suite 1316 <br />South Bend, IN. 46601 <br />ACORD 75 (2016/03) <br />AM 1 12:01 AM <br />10-01-2024 12:01 PM 10-31-2024 NOON <br />(574) 586-7277 THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY <br />PER EXPIRING POLICY $: <br />DESCRIPTION OF OPERATIONS! VEHICLES I PROPERTY (Induding Location) <br />2413 Prairie Ave <br />South Bend, IN 46614-4267 <br />COVERAGEIFORMS <br />SCHEDULED VEHICLES <br />I ImiTS <br />DEDUCTIBLE <br />EACH OCCURRENCE <br />COINS% <br />AMOUNT <br />$ 2,000,000 <br />DAM" <br />RFNTEDPRE <br />$ 300,000 <br />MED EXP (Any oneperson) <br />$ 10,000 <br />PERSONAL BADVINJURY <br />$ 1,000,000 <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PRODUCTS -COMPIOPAGG <br />COMBINED SINGLE LIMIT <br />$ 2,000,000 <br />$ <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />$ <br />MEDICAL PAYMENTS <br />$ <br />PERSONAL INJURY PROT <br />$ <br />UNINSURED MOTORIST <br />$ <br />ACTUAL CASH VALUE <br />$ <br />$ <br />STATED AMOUNT <br />AUTO ONLY -EA ACCIDENT <br />OTHER THAN AUTO ONLY: <br />EACH ACCIDENT <br />$ <br />AGGREGATE <br />EACH OCCURRENCE <br />$ <br />$ 4,000,000 <br />AGGREGATE <br />$ 4,000,000 <br />SELF -INSURED RETENTION <br />PER STATUTE <br />$ 10,00-0 <br />E.L. EACH ACCIDENT <br />$ <br />E.L DISEASE - EA EMPLOYEE <br />$ <br />E.L. DISEASE - POLICY LIMIT <br />FEES <br />$ <br />$ <br />TAXES <br />$ <br />ESTIMATED TOTAL PREMIUM <br />$ <br />ADDITIONAL INSURED LOSS PAYEE u MORTGAGEE <br />LENDER'S LOSS PAYABLE <br />LOAN * <br />C=A&- 4• , Agent <br />Page 1 of 2 ©1993-2016 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />