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DATE(MiUDD1YYYY) AC40R n CERTIFICATE OF LIABILITY INSURANCE 03/27/2013 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 lieu of such endorsement(s). CoN -CT PRODUCER NAM : John Adams PHONE1-800-316-6705 No: 1-888.467-2378 williS of Illinois, Inc. mal lionsclubs@willis.com 425 N. Martingale Road, Suite 1100 ADDRESS: IL 60173 INSURER s AFr-oRaNc N;NWERACE # Schaumburg, INSURER A: ACE American Insurance Company 22667 INSURED INSURER 8: INSURER C: Centerville Lions Club-5M7 INSURER D: Centerville Minnesota INSURER E INSUREIF: 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 POLICY E F POW Y EXP LIMITS LTR TYPE OF INSDL SUOR URANCE POLICY NUMBER MM1 MM Nyrn A GENERAL LIABILITY EACH OCCURRENCE S 1, �� X COMMERCIAL GENERAL LIABILITY X HDOG27012784 09/0112012 09101!2013 PREMISES Ea occurencee S 1'000'000 CLAIMS-MADE X OCCUR MED EXP one son S 1,000 gaa Per Named Insured PERSONAL&ADV INJURY $ 1,000,000 is$2,000,000 GENERAL AGGREGATE $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS•COMPIOP AGG S 2.000,000 X POLICY PRC LOC S A AUTOMOBILE LIABILITY Ea I�IN�SINGLE LIMIT 1000,000 ISAH08711392 09/0112012 09/01/2013 BODILY IWURY(per person) s ANY AUTO ALL OWNED SCHEDULED BODILY IWURY(Per accbenq S AUTOS AUTOS PRR DAMAGE NON-OWNEO S MIRED AUTOS AUTOS ri S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S 'RI S DEC RETENTIONS WC STATU• DTI+ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNE ECUTIVE YIN E L EACH ACCIDENT S OFFICER/MEM8ER EXCL D-) NIA (� E L DISEASE-EA EMPLOYEE S (Myyar5mlatory in NH) l DESCRIPTION OF RATIONS below E L DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPE TIONS I LOCATIONS I VEN ES,(Anath ACORD 101,Additional Remarks Sc k.I more e k required) -- Provisions of the po"cy apply to the nam insu7eds participation in the following a ivity durin a policy period shown above:Festival of Lakes,July 26,27,28 2013 City of Centerville is in uded as an Additional Insured(s),but only with respe o Gene Liability arising out of the use of premises by the Insured shown above and not out of the sole n ligence of said additional insured. PROVISIONS OF THE P ICY DO NOTAPPLYTO THE SALE OR SER NG ALCOHOLIC BEVERAGES CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Centerville THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN 1880 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Centerville Minnesota 55038 AUTHORIZED REPRESENTATIVE �+ ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 37