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ARV CERTIFICATE OF LIABILITY INSURANCE D10DrYYYY) 09 /2 013 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 the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CON PRODUCER NAME; John Adams PHONE 1800- 3166705 C. No: 1- 88867 -2378 Willis of Illinois, Inc. E-MAU- lionsclubs�wiliis.com 425 N. Martingale Road, Suite 1100 ADDRESS: IN I L 60173 SU S AIL AFFORDING COVERAGE N s Schaumburg INSU A. ACE American Insurance Company 22667 INSURED INSURER B: INSURER C : Centerville Lions Club - 5M7 INSURER D: Centerville Minnesota INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 POLK Y EFF POLICY EXP LIMITS L JR TYPE OF INSURANCE POLICY NUMBER MMID (MMOD A GENERAL LIABILITY EACH OCCURRENCE S 1.000.000 r X Col.lr&R GENERAL LIAB ICTY HDOG27022923 09 /01/2013 09/01/2014 PREM ISES E occurrence S 1 ,000,000 CiAMAS MAOE ❑X OCCJR ►0 EXP (ArN ore ) S 1.000 Asag Per Named Insured PERSONAL b ADV INJURY S 1,000,000 Is $2,000,000 GENERAL AGGREGATE S 10,000,000 GENL AGGREGATE LWIT APPLIES PER PRODUCTS - COi�lOP AGG S 2,000,000 X P ICY PRQ LOC S C, A AUTOMOBILE LIABILITY tFa IB SINGLE LIhNT S included apcxieeviti ISAH08721415 /0112013 09/01/2014 BODILYINJURY(PerW,,,) S ANY AUTO ALL OWNED SCHEDULE[) BODILY INJURY (Per accaerr,) S AUTOS PROPERTY DAMAGE NON -OWNED per acacie- 1: S HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIRIS-MADE AGGREGATE S S DED RETENTIONS WC STATU• O1N- WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETORIPARTNER'EXECU N t A TIVE ❑ E L EACH ACCIDENT S FF Ma CERI y tin NN) EXCLUOED1 E.L. DISEASE - EA EMPLO S DESCRIP OF OPERATIONS Delox E L DISEASE - POLICY LIIAIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule. It more sales is required) Provisions of the policy apply to the named insureds participation in the following activity during the policy period shown above: Centerville Lions Haunted House, Oct. 25, 26 2013 City of Centerville is included as an Additional Insured(s), but only with respect to General Liability arising out of the issuance of permit(s) to the Insured shown above and not out of the sole negligence of said additional insured. PROVISIONS OF THE POLICY DO NOT APPLY TO THE SALE OR SERVING OF ALCOHOLIC BEVERAGES CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Centerville THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1880 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Centerville Minnesota 55038 AUTHORIZED REPRESENTATIVE ea4-r ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD