2011-09-28 CC Packet - Laserfiche WebLink

Home Browse Search

"� o e CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 99/1 /2 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 certificate holder Is an ADDITIONAL INSURED, the pollcy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and condklons of the policy, certain policies may require an endorsement. A statement on thls certificate does not conferrights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT MAW- Millis of Illinois, Inc. PHONE FAX 26 Century Blvd. am. Nn FX4 877 - 945 - 7378 pr Nn)• 888- 467 -2378 P. O. Box 305191 E-MAIL nRRC Cart 1f 2Catee®wallie. COm Nashville, TN 37230 -5191 INSURER(S)AFFORDING COVERAGE NAIL* INSURERA ACE American Insurance Company 22667 -002 INSURED INSURER B: Centerville Lions Club 7155 Brian Drive INSURERC: Centerville, MN 55038 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 16521674 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 REOUIREMENT, 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. � TR TYPE OF INSURANCE ADD SUER POLICY NUMBER ownomyY 1 POLICY n w I LIMITS A GENERAL LIABILITY Y HD0G25531541 9/1/2011 9/1/2012 EACH $ 1,000,000 PREM X COMMERCIAL GENERAL LIABILITY Ee gq renal $ 1,000,000 CLAIMS -MADE X OCCUR MEDEXP(Any one person) $ 1,000 X Ace Per Named Insured PERSONAL&ADV INJURY $ 1,000, 000 X is 82,000,000 GENERAL AGGREGATE $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2,000,000 7 POLICY f 7.46 fl LOC $ A AUTOMOBILE LIABILITY BDOG25520154 9/1/2011 9/1/2012 _COM J EEDSINGLE LIMIT $Included ANY AUTO BODILY INJURY(Pr person) $ ALL OWNED SCHEDULED BODILY INJURY(Pracdtlenl) $ AUTOS AUTOS X HIRED AUTOS X NON -OWNED PROPERTY (DAMAGE AUTOS (Praccdenl) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED (RETENTION$ $ WORKERS COMPENSATION W1. SIAI U- 10TH- AND EMPLOYERS' LIABILITY � TORY 1 IIAITC FR ANY PROPRIETOR/PARTNER/EXECUTIVE N E.L. EACH ACCIDENT $ OFFICEROdEMBE EXCLUDED? IW d dayr lnNn)r E.L. DISEASE -EA EMPLOYEE $ tl DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Ansel) Aard 101,AddNenal Remarks Schedule. If mammals required) * ** PROVISIONS OF THE POLICY DO NOT APPLY TO THE SALE OR SERVING OP ALCOHOLIC BEVERAGES see Provision of the policy apply to the Named Insureds participation in the following activity during the policy period shown above: 2011 Centerville Lions Haunted House Event. Event Date: 10/21, 10/22, 10/28, 10/29, 2011 Location: Laurie Lallotte Memorial Park, Centerville 811. 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 PROVISIONS. AUTHORED REPRESENTATIVE City of Centerville 1880 Main Street ^ Centerville, MN 55038 /1 i 1 Y l c coal: 3482576 Tp1:1312953 Cert:16521674 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 21