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'�� CERTIFICATE OF LIABILITY INSURANCE paqe 1 of 2 o3i 3i2`o ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER3 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(les)must be endorsed. If SUBROQATION IS WAIVED, subject to the terms and conditions ofthe policy, certain policies may require an endorsement. A statement on thls certiflcate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT � � Willis of Illinois, Iac. PHONE "_ _,� ,7 FAX 8_ 6�-2 , �s 26 Century Slvd. P. o. eox 305191 E-AA° ce tiff a e illi . m Nashville, TN 37230-5191 �►��RS FQRDINGCAVERAGE NNC# ' INSURERA:ACB Americaa Insurance Comgany 22667-002 INSURED � � ' Centerville Lione Club INSURERB: 7155 Briaa Drive INSURERC: Centarv311e, � 55038 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:15598196 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 TypEOFINSURANCE D' SUB pOLICYNUMBER P��CYEFF POLICYEXP LIMITS p, GENEruLUaBILmr Y SDOG25520154 9/1/2010 9/1/2011 enCHOCCURttENCE S 1 000 000 $ COMMERCIAL GENERAL LIABILI7Y - DAMA E O RENTED � P MI Eaxcwrence $ 1 000 000 CLAIMS-MADE� OCCUR MEDEXP(Myaiepetson S 1 000 000 X Attc. Per NBII�E IAetlr'ed PERSONALBADVINJURY S 1 000 X i8 S2,000,000 GENERALAGGREGATE S lO O OO GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG E 2 OOO OOO X POLICY PRa LOC $ j� AUTOMOBILELIABILITY 8DOG25520154 �1�2010 9�1�2011 �BINEDSINGLELIMIT eaaccidern gIacluded ANYAU70 . BODILYINJURY(P�person) $ AILOWNED SCHEDULED AUTOS AUTOS BODILYINJURY(Peraccidenl) S X HIREDAU70S X A�� NED ��p�E,R� a ) . _ UMBRELLALIAB OCCUR EACHOCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE 3 DED RETENTION S S WORKERS COMPENSATION � ANDEMPLOYERS'LIABILITY Y�N ANYPROPRIETORIPARTNER/EXECUTIVE� N � A E.L.EACHACGDENT $ OFFICER/MEMBER EXCLUDEDI (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ rf yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY UAAIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach A�td 101, Additonal Romarks Sdnduk, H mon space k requlred) *** PROVISIONS OF Tffi POLICY DO NOT APPLY TO T88 SALB OR SBRVIN(3 OF ALCO80LIC SEVBRA�ffiS *** Provision o£ the policy apply to the Named Insurede participation in the followiag activity during the policy period ehown above: 2011 Csnterville Lions 8aster 8gg Huat, 4/23/2011 at Laurie LaMotte Memorial Park, Centerville �i City of Centerville ia included as an Additioanl Ineured, but oaly with respect to General - Li il 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 PROVIStONS. AUTHORIZED REPRE8ENTATIVE Cit of Ceatervilla 1880 Main Street ^ Centerville, �1 55038 ` � Co11:3286171 Tp1:1133739 Cert:15598196 �1988-2010ACORDCORPORATION.Allrightsreserved. ACORD 25 (2070105) The ACORD name and logo are registered marks of ACORD 22 I_ _ _ _-.__ _ _