2018-06-27 Set Agenda Packet - Laserfiche WebLink

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DATE(MM;DDIYYYY) ACC)I?" CERTIFICATE OF LIABILITY INSURANCE 06/14/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES N07 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). PRODUCER CONTACT NAME: John Adams DSP Insurance 1C NNo.E:t 1-800-316-8705 A1C.No 1-888-467-2378 1900 E. Golf Road, Suite 650 E-MAIL liansclubsn[7dspins.Corn Schaumburg, IL 60173 INSURERS AFFORDING COVERAGE NAIL# INSURER A: ACE American Insurance Company 22667 INSURED INSURER B INSURER C Centerville Lions-5M7 Centerville Minnesota INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELCAN HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR T-IE POLICY PERIOD INDICATED NOT1^,ITHSTANDING ANY REQUIREMENT TERNI OR CONDITION OF ANY CON-RACT OR O-HER DOCUNIEN- V.1ITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED IDR VAY PERTAIN. THE INSURANCE AFFORDED BY THE PrOLIl;IES DESCRIBED HEREIN IS SUBJECT TO AL- THE TERMS. EXCLUSIONS AND C01DI-I ONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID'.CLAINIS INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM;DD.YYYY MMIDDNYYY A GENERAL LIABILITY EACH OCCURRENCE S t000.000 X COMMERCIAL GENERAL LIABILI-' HDOG27867431 09/01/2017 09/0112018 PREMISES(Ea occurrence S 1,000,000 L'LAIVS-F:ASE 1XI OCCUR MED=XP(Aw one person) S 5.000 X Agg, Per Named Insured PERSONAL&AD.'INJURY S 1,000,000 Is 52.000,1300 GENERAL AGGREGATE S 10.000,000 GEN'L AGGREGATE LIMIT APP,IES PER PRODUCTS-COMPICP ACG 5 2,000,000 x POL ICY PRD LOC S p AUTOMOBILE LIABILITY BINED EaF""dennt.�NGLE LI',IIT S 1,000,000 ANY AUTO ISAH09061046 09/01/2017 09/01/2018 30DILYINJURYePer„e-sanj S ALL OWNED SCHEDULEDBOD]I.YINJl1RYtPeraccdentl S AUTOS AUTOS _ NON-OIA''NED PROPERTY UAMASE S X HIRED AUTOS AUTOS Per acciaen: 5 UMBRELLA LIAB OCCUR EACH OCC4.RRENCE S EXCESS LIAR CLAI?:1S-L'ADE AGGREGATE S DED RETENTION S S WORKERS COMPENSATION '.dC STATU• OTRH AND EMPLOYERS'LIABILITY YIN ANY PROPR ETOR PARTNER+EXECUTI.'EE.L.EACH ACCIDENT S OF=CER;MEI.'8�R EXCLUDED F-1N I A {Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 5 r YY'2S,c1eSCri bE url der Dt3LRIPTION pF OPERATIONS helor+ E L UISEASE-POLICY LIMI T S DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (Attach ACORD 1p7,A[Irlitlonal Remarks 5cheAule,if more space is requiredl Provisions of the policy apply to the named insureds participation in the following activity during the policy period shown above:2018 Fete des Lacs Festival City of Centerville 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 NOTAPPLY 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 55038 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 22 (c; 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25{2010)05) The ACORD name and logo are registered marks of ACORD