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ACCMEP CERTIFICATE OF LIABILITY INSURANCEDA"'"M oiYYYY' 12/02/2015 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), AUTHOR' REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: H the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. It 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). PRODUCER John Adams DSP Insurance PHONE[". 1-800-316-6705 No: 1-868467-2378 1900 E. Golf Road, Suite 650 =Ss. lionsclubs@dspins.com Schaumburg, IL 60173 s AFFORWMCOVERAM MAIC* INSURER A: ACE Arrlerkan Insurance Company 22667 INSURED INSURER 6: Centerville Lions Club-5M7 INSURER C: Centerville Minnesota INSURER D: INSURER E: INSURER F: COVERAGE$ 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 TYPE OF INSURANCE POLICY NUMBER POLICY M L Y LIMITS A GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X eommERct&GENERAL LIABILITY HDOG27396392 09/01/2015 09/01/2016 - 15 PRp pe g aooulelloe S 1,000,000 Cx PASAIADE D OCCUR MED EXP vft one S 5,000 X Aga.Per Named Insured PERSONAL&ADVINIAW s 1,000,000 is$2,000,000 GENERAL AGGREGATE S 10,000,000 GERL AGGREGATE LIMIT APPLIES PM PRODUCTS-COMAIOP AGG s 2,000,000 X POLICY PRO• LOC f A AUTOMOBILE LIABILrrYcoMBINED INGLE LIMIT 1,OD0,000 ANY AUTO ISAH08858354 09/01/2015 09/01/2016 BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY(Per went) S HIREDAUTOS NON-OWNED PROPERTY GE S AUTOSS UMBRELLA LIABOCCUR EACH OCCURRENCE S EXCESS I" CLAIMS44ADE AGGREGATE S DED RETENTION S S WORKERS COMPENSATION WC STATU• OZ EMPLOYERS'LIABILrrY YIN LIMITS ANY PROPRIETOPJPARTNERIEXECUTIVE E.L.EACH ACCIDENT S OFFICERA�MBER EXCLUDED? N I A { under .L.in NN) EDISEASE-EA RELO $ WTION OPERATIONS below I E.L DISEASE-POLICY LIMIT I S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101.Additional Remarks Schedule,I more space Is retiuked) Provisions of the policy apply to the named insureds participation in the following activity during the policy period shown above:Centerville Lions Ice Fishing Contest-2/20/2016 Anoka County Parks&Recreation,550 Bunker Lake Blvd NW,Andover,MN 55304,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 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 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 6 ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 96