|
� 0 DATE IMIAMINYYYY)
<br /> AC"J?" CERTIFICATE OF LIABILITY INSURANCE
<br /> E0,13/13/2019
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THIS POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME: John Adairns
<br /> A
<br /> DSP Insurance Ew: 1-800-316-6705 �'Aj C"NO: 847-,934-,6186
<br /> E-MAIL lionsclubs@dspins,coml
<br /> 1900 E. Goll Road�, Mite 650 ---- - - ------------------------------
<br /> Schaumburg, IL 60173 INSURER(S)AFFORDING COVERAGE NMC N
<br /> INSURER A: ACE American Insurance Company 22667
<br /> INSURED INSURER B
<br /> INSUR
<br /> —I-INSURER E':............................................................................................................................
<br /> INSURER C:
<br /> Centerville Lions-5M7
<br /> Centerville Minnesota
<br /> INSURER P:
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLIC'IES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> IN1DK",A"r1ED, INC)TWITHSTANDINCi ANY REQUIREMENT, TERM OR C',C)NDITION M')F ANY CONTRACT oR OTHER WITH RESPECT To WHIC'H THIS
<br /> CEIRTIPICA"It MAY HIE ISSI.IED ()R MAY PERTAIN, THE N$L)RANCE APR".)RDED BY THE 9-°(')1..1IKAES DESCRIBED HEREIN IS SI1,113JEC I 10 ALL 'T'HE TERN'ls'
<br /> EXCLUSIONS AND CONDITIONS C)F SI, .F POLICIES LIMITS SHOWN MAY HAVE BEEN RI BY PAID CLAIMS
<br /> INSIR ADDL SUER POILK EFF PO L11 Y 1XII
<br /> t M�r%Y
<br /> ly�
<br /> .LTR TYPE OF INSURANCE 111511 POLICY NUMBER M yyl� (MIMI1001yyyYI LIMITS
<br /> A GENERAL LIABILITY EACH OCCUPPENCE y 1,000,000
<br /> X COPMAEROAL GENERAL LIASIUTY HIDOG71094972 09/01/2018 09/01/2019 DAMAUt URtWtU 1,000,000
<br /> DC-LAIMS4AADE 1XI OCCUR -PA,EDIXE(ATK29�R�M2L-15 5,0101011111111111111111
<br /> X Acin.Per Named Insured PERSONAL&ADV INJURY S 1,000,000
<br /> is$2,000,000 10,000,0001
<br /> GENT-AGGREGATE LIFAT APPLIES PER PRODUCTS,CONIP10P AGG 2,000,000
<br /> x] POLICY PC F7 LOC $
<br /> AUTOMOBILE LIABILArY C&ABINED SINGLE LIMIT 1,0110,000
<br /> ANY AUTO ISAI-125159226 09/01/2018 09/0112019 B01MLY INJURY(Per pemn) $
<br /> ALL OWNED SCHEDULED
<br /> 8C;DII Y INJURY(Per accideno S
<br /> AI,UTI,SEa AU10S
<br /> N(`)N-C)1dVNE[k
<br /> HIREDAUTOS AUTOS Iperaccijdert�
<br /> PRC)PEid'
<br /> IJM8 R E L I L IA8 OCCUR EACH OCCURRENCE S
<br /> EXCESS HAD L CLAIINIS-MAIDE N3(,REGATE 51
<br /> DED RETENTVON S S
<br /> WORKERS COMPENSAT110,114 T","'11h,,STA II
<br /> "I"J A
<br /> AND EMKOYERVI.IABILITY YIN " . 1 11-
<br /> ANY PROPrR]ETOR!/PAIRTNER,tEXEcur�VE ELEACH:ACCIDENT S
<br /> OFF�CERMIF 110H,EIR EXCLUDEW NIA
<br /> (Mand3tory in NIH) E .IMSEASE ,EA EMPLOYEE $
<br /> DAs,desvbL under
<br /> SCRIPTT)IN OF OPERAT111DINS belwe E L MSEASE- "OLiCY 1.0011' S
<br /> DESCRIPTION OF OPERA I IIONS[AL.00.AI IONS P VEHIC1 ES
<br /> Provisions of the policy apply to the named insureds participation in the following activity during the policy period shown above:Cadillac Dinner,Saturday April
<br /> 27th 2019
<br /> The following persons or organizations granting use of real property, including structures thereon are included as Additional Insured(s), but only with respect to
<br /> 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.
<br /> St. Genevieve Parrish Center
<br /> PROVISIONS OF THE POLICY DO NOT APPLY TO THE SALE OR SERVING OF ALCOHOLIC BEVERAGES
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> St. Genevieve Parrish Center SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> 6995 Centerville Rd THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> CENTERVILLE Minnesota 55038-8729 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> AW'HOIRIIZED REPIRESIEN FAINE
<br /> 44 1988-2010 ACORID CORPORAT110N. All rights reserved.
<br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
<br />
|