2013-11-06 P & R Packet - Laserfiche WebLink

Home Browse Search

AFRO® r DATE 9 /16 / 0 CERTIFICATE OF LIABILITY INSURANCE MroDnrrYY) 09/16/2013 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 iieu of such endorsement(s). PRODUCER NAME: John Adams PHONE 11 * 1$00-316-6705 F AI AX C No: 1- 888467 -2378 Willis of Illinois, Inc. MAIL lionsdubs@willis.com 425 N. Martingale Road, Suite 1100 ADDRESS: I L 60173 INSURERS) AFFORDING COVER — # Schaumburg, INSURER A: ACE American Insurance Company 2266 INSURED INSURER 8: 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 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 MW BRI POLK Y EFF POLICY EXP LIMBS W R TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY IDO A GENERAL LIABILITY EACH OCCURRENCE S 1 .000,00 X COMMERC AL GENERAL LIABILITY HDOG27022923 09/01/2013 09/01/2014 PREIMSES IE1 occurrence S 1,000 CLA1tASMADE a OCCJR WED EXPI ane ersan) S 1,000 PERSONAL a ADV INJURY s 1,000,000 X Agg Per Named Insured is $2,000,000 GENERAL AGGREGATE S 10,000,000 GENL AGGREGATE LY.!IT APP.IES PER PRODUCTS - COIAPIOP AGG S 2,000,000 X PO. -ICY PRO LOC S A AUTOMOBILE LIABILITY COMBINED accWt SINGLE LIMIT S Included ISAH08721415 09/01/2013 09/0112014 BODILY IN NR2Y (per pe-5)n) s ANY AUTO ALL OWNED SCHEDULED BODI. Y INJURY (Per acedent) 5 AUTOS — NON-OWNED PROPER DAMAGE S NIREDAUTOS AUTOS Peracc 5 UMBRELLA LIAR [ TOCCJR EACH OCClR RENCE S EXCESS LIAR LAItAS4.%DE AGGREGATE S S DEO RETENTIONS tYC STATU• OTH- WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRiETORIPARTNEWEXECUTNE YIN E L EACH ACCIDENT S ^ - OFFICERIMEMBER EXCLUDED? NIA (Mandatory in NN) E.l DISEASE • EA EWLOYEE S ; SdRi TION OF bebv. El DISEASE -POLICY LIAT 5 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. Additional Remarks Schedule. It more space is required) Provisions of the policy apply to the named insureds participation in the following activity during the policy period shown above. Centerville Lions Oktoberfest, Oct. 19th 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 01988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD