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Special Event - March for Life-South Bend 2025-Jan 17, 2025
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Special Event - March for Life-South Bend 2025-Jan 17, 2025
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4/17/2025 10:24:03 AM
Creation date
11/26/2024 2:02:06 PM
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Board of Public Works
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Projects
Document Date
11/26/2024
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CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DDNYYY) <br />11/6/2024 <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 POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />UPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />PORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(sl. <br />PRODUCER CUNIACT <br />Synergy LLC NAME: SO his Dhuivetter <br />13800 Jackson Rd. PHONN 574-23"566 <br />Mishawaka IN 46544 no E.- Gservice0svnen <br />INSURED <br />Right to Life Michiana Education Fund, Inc. <br />2004 Ironwood Circle Suite 130 <br />South Bend IN 46635-1800 <br />COVERAGES CERTIFICATE NUMBER: 873240359 REVISION NUMBER' <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />I TYPE OF INSURANCE <br />AD0 <br />POUCYNUMBER <br />POLICY EFF <br />MNIDDIYYYY) <br />POLICY EXP <br />(MNUDDYYYYJ <br />LIMBS <br />A <br />X <br />COMMERCIAL GENERAL LIABIUTY <br />Y <br />9676284200 <br />9/28/2024 <br />912M025 <br />EACH OCCURRENCE <br />$1,000,000 <br />PREMISES Ea occurrence <br />$50,000 <br />CLAIMS -MADE FxIOCCUR <br />MED EXP (Any one person) <br />$ 5,000 <br />PERSONAL S ADV INJURY <br />$ <br />GENL <br />X <br />AGGREGATE LIMITAPPLIES PER: <br />POLICY ❑jEC LOC <br />GENERAL AGGREGATE <br />$2,D00,0D0 <br />PRODUCTS.COMP/OP AGG <br />$1,000,000 <br />$ <br />OTHER: <br />UTOMOBILELIABIL" <br />5438855300 <br />3/13/2024 <br />3/132025 <br />COMBINEDSINGLELIMIT <br />$1,000,OD0 <br />X <br />ANY AUTO <br />BODILY INJURY Per person) <br />E <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />Par accident <br />$ <br />$ <br />UMBRELLALULB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAS <br />CLAIMS -MADE <br />DED <br />RETENTION <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS'LUUBLDY YIN <br />ANYPROPRIETORIPARTNERIEXECWWE <br />OFFICERIMEMBEREXCLUDED'! ❑ <br />NIA <br />A106592005 <br />6/182024 <br />5/182025 <br />X STATUTE ER <br />E.L. EACH CH ACCIDENT <br />$500,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$500,000 <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS bebw <br />E.L. DISEASE-POLICYiMRT <br />$WO,DDD <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />The City of South Bend is listed as an additional insured. <br />• The City of South Bend <br />Public Works Service Center <br />731 S. Lafayette Blvd <br />South Bend IN 46601 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />A�UTH�ORIIZZEEDD'REPRESENTATIVE <br />(Ed{/yf's'r�sa/ <br />ACORD 25 (2016/03) <br />(B) 1988-2015 ACORn <br />The ACORD name and logo are registered marks of ACORD <br />All rin Hfe m --r! <br />
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