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AC ox d CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 DATE 22/20 ' THIS CERTIFICATE IS ISSUED ASA 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 policy(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 this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER CONTACT NAME Willis of Illinois, Inc. PHONE Nn Fxrr 877 945 - 7378 FAX Nn 888 467 - 2378 26 Century Blvd. rWc )' P. O. Box 305191 E -MAIL Anr Nashville, TN 37230 -5191 wFao- certif INSURER(S)AFFORDINGCOVERAGE NAICY INSURERA ACE American Insurance Company 22667 -002 INSURED Centerville Lions Club INSURERS: 7155 Brian Drive INSURER C: Centerville, EN 55038 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 16521674 REVISION NUMBER: THIS 15 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. im TYPEOF INSURANCE MS n POLICY POLICY NUMBER ,nnryyl 1 UNITS A GENERAL LIABILJTY Y HDOG25531541 9/1/2011 9/1/2012 E �OOCTCURRENCE $ 1,000,000 PREM X COMMERCIAL GENERAL LIABILITY ISES( 5 1,000,000 CLAIMS -MADE X IOCCUR MED EXP (Anyone person) $ 1.000 X ADO Per Named Insured PERSONAL 8 ADV INJURY $ 1,000,000 X is 82,000.000 GENERAL AGGREGATE $ 10.000.000 G AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY 'F° LOC $ A AUTOMOBILE LIABILITY 800025520154 9/1/2011 9/1/2012 OMBIINEDIINGLE LIMIT $Included ANY AUTO BODILY INJURY /Par Person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED Ppn AUTOS (Parara 3 UMBRELLA LIAR OCCUR EACH OCCURRENCE 5 EXCESS LIAB CLAIMS-MADE AGGREGATE 3 OED I (RETENTION$ $ WORKERS COMPENSATION WC STATU OTH AND EMPLOYERS' LIABILITY YIN TORY IOMITC FR ANY PROPRIETOR/PARTNER/EXECUTIVE I N/A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ryerMetaVin NH) E.L. DISEASE - EA EMPLOYEE $ 8 yes, deambe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 5 DESCRWTON OF OPERATIONS/ LOCATIONS /VEHICLES (Attach Acord 101, Addttonel Remarks Sa X more macs Is rpulnd) * ** PROVISIONS OF THE POLICY DO NOT APPLY TO THE SALE OR SERVING OF ALCOHOLIC BEVERAGES * ** 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 Lamotte Memorial Park, Centerville td. 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. AUTHORIZED REPRESENTATIVE City of Centerville 1880 main Street Centerville, RN 55038 Coll:3482576 Tpl :1312953 Cert: 16521674 C1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD