2015-01-14 CC Agenda Packet - Laserfiche WebLink

Home Browse Search

Acos CERTIFICATE OF LIABILITY INSURANCE 1 1091MIDWYYYY) 12/09/2014 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(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. It SUBROGATION IS WAIVED,subject t�_ 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). PRODUCER We:CT John Adams Willis of Illinois, Inc. PHONE 1-s 1"705 w No: 1-8W467-2378 425 N. Martingale Road, Suite 1100 A R s: lionsclubs@vrillis.corn IL 60173 INSURER s AFFORDWO COVERAGE MAIC# Schaumburg, INSURER A: ACE American Insurance Company 22667 INSURED INSURER 0: 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 LTR TYPE OF INSURANCE POLICY NUMBER MMILDDIYYYY MMOICY EFF DIYYY LIMITS A GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY HDOG27338395 09/01/2014 09/01/2015PREMISES Eaocagrence $ 1,000,000 CLAIMS MADE OX OCCUR MED EXP LAa one S 5,000 egg.Per Named Insured PERsoNAI.aADvlNJuIRY s 1,000,000 is$2,000,000 -GENERAL-AGGREGATE S 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG s 2,000,000 X POLICY PRo F71 Loc I S A AUTOMOBILE LIABILITY COMBINED��MSINGLE LIMIT 1,000,000 ANY AUTO ISAH08827552 09101/2014 09/01/2015 BODILY INJURY(Per person) s SO OWNED AUTOS BODILY INJURY(Per aoddent) S HIRED AUTOS AUTOS PR08ER�N DAMAGE S S UMBRELLA WB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S DED I I RETENTION S S WORKERS COMPENSATION I ViIC STATU OTH AND EMPLOYERS'LMILRTY Y/NER ANY PROPRIETOR/PARTNERIEXECUTIVE❑ N/A E.L.EACH ACCIDENT S OFFICERIAEMBER EXCLUDED? �QANUMtory M NH) E.L.DISEASE-EA EMPLOYEES unaw DESCi.RIPTION OF OPERATIONS bekW E.L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Addi tonal Remwke Schedule,N more space Is required) Provisions of the policy apply to the named insureds participation In the following activity during the policy period shown above:Lion Ice Fishing Contest and Free Airplane Rides Anoka County Sheriff, 13301 Hanson Blvd NW,Andover,MN 55304 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 City of Centerville SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1880 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Centerville Minnesota 55038 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 64424- 0 1988-2010 4424—®1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 50