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AcoRp� CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DoiIYYYY)�J 2/05/2014 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), AUTHORRF` 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 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 ME; John Adams Willis of Illinois, Inc. NE • 1-600-316-6705 � No: 1-888467-2378 E41111425 N. Martingale Road, Suite 1100 DD ESS: lionsclubsowillis.com Schaumburg, IL 60173 INSURERIS)AFFORDNGCOVERAGE NwcII INSURER A: ACE American Insurance Company 22667 INSURED INSURER B: Centerville Lions Club-5M7 INSURER C: Centerville Minnesota INSURER 0: 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 INSLTR TYPE AUIXTYPE OF INSURANCE POLICY NUMBER MMMMIID POLICY SUBR F MOMIIDDIYYYLICY Y LIMITS A GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 XC RCIALGENERAL LIABIUTY HDOG27022923 09/01/2013 09/01/2014 PREMI�Eaa to S 1,000,000 CLAINISa.ADE I OCCUR MED EXP One S 1,000 X Mo.Per Named Insured PERSONAL 3 ADV INJURY S 1,000,000 is$2,000,000 GENERAL AGGREGATE $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMp/Op AGG S 2,000,000 X PRQ POLICY LOC S A AUTOMOBILE LIABILITY BOMB MSINGLE LUT inClUded AN AUTO ISAH08721415 09/01/2013 09/01!2014 BODILY INJURY(Per person) S ALL OWNED AUTOS AUT ED BODILY INJURY(Per Koderit) S HIRED AUTOS AUTOS PR08ER DAMA E S S UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIWMADE AGGREGATE S DED I I RETENTION S S WORKERS COMPENSATIONWC TATU- OTH- AND EMPLOYERS'LIABILITY YIN 9BS ANY PROPRIETORIPARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED NIA E.L EACH ACCIDENT S "Wwatwy M NH) E.L.DISEASE-EA EMPLOYEE S under DESC:RIP 10"N OF OPERATIONS below E L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS r VEHICLES (Attach ACORD 101.Additional Remarks Schedule,H more space is roquired) Provisions of the policy apply to the named insureds participation in the following activity during the policy period shown above:Centerville Lions Cadillac Dinner St.Genevieve Church,6995 Centerville Road,Centerville,MN 55038 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 Q 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 42