2015-01-14 CC Agenda Packet - Laserfiche WebLink

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co v" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/pp►yYYY) 10/31/2014 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(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 en s. PRODUCER .IOhn Adams Al Willis of Illinois, Inc. MM-E'1: 14W31"705 1 MA1 7 2 7 425 N. Martingale Road, Suite 1100 lionsclubsewillis.com Schaumburg, IL 60173 AFFORDINGCONIIR1OE NAICI INSURER A: ACE American Insurarwe Company 22667 INSURED INSURER B Centerville Lions Club-5M7 INSURER C Centerville Minnesota INSURER D: 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. ra TYPE OF INSURANCE POLICY NUMBER Y UNITS A GENERAL LI"w" EACH OCCURRENCE S 1,000,000 X comw wGENERALLMB-rrY HDOG27336395 09101/2014 09/01/201 Nems 17— S 1,000,000 CLAwLSMADE QX OCCUR MED EW one S 5,000 AN.Per Named Insured PERSONAL a ADVMLIURY S 1,000,000 is$2,000,000 GENERAL AGGREGATE S 10,000,000 GENL AGGREGATE UMIT APPLIES FM FRooucTs-comp/op AGG s 2,000,000 T POL,CY Pm Loc S AUTOMOBILE LIABILITY ,cauenn L1,000,000 AW AMO ISAH08827552 1/2014 09/0112015 aY��'(Pff PMW) S AMSCHEDULED �NED �OS BODILY*UURY(Pu aco*m S NON-OWNED par—MIRED AUTOS AUT wyaoda"M S S UMOMMLLA LNAB OOCUR EACH OOCURRENCE S 4 EXCESS LIAR I CLANAS-MADE AGGREGATE S DED I I RE7EMION S S WORKERS COMPENSATION A AND EMPLOYERS'LLABILITY Y I N ANY PROPRETORIPARTNEPAXECUTIVE aNIA E.L.EACH ACCIDENT S OFFICERIMyam in"R EXCWDEO7 E.L.DISEASE-EA ENPI.OY S OFSCRIPTtONFOOPERATIONS below E L.DISEASE-PoUCY LOGIT I S DESCRrTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Ansch ACORD 181,AddMionel Rsmwks Sehsduls.I mow spam b naulndl Provisions of the policy apply to the named insureds participation in the following activity during the policy period shown above:Lions Ice Fishing Contest and Free Airplane Rides,Saturday February 21,2015 Anoka County Parks&Recreation,550 Bunker Lake Blvd NW,Andover,MN 55304 is included as an Additional Insured(s),but only with respect to General Liability arising out of the use of premises by 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 Anoka County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2100 3rd Ave. THE EXPIRATION DAT THEREOF, NOTICE WILL BE DELIVERED IN Anoka Minnesota 55303 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORQEO REPRESENTATIVE ®1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 49