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<br />ACrnDCERTlFICA TE OF LIABILITY INSURANCE MlE~ I <br /> ... Uune 16, 2006 <br />PRODUCER (630)324-2500 FAX (630)324-2501 CN..Y MDcx::NR:RSN>RlGHlSl.PCNll-Eu:KI...:;AlE <br />T. J. Adams Group, a HUb Rogal & Hobbs Company <br />333 E. Butterfield Rd., SUite 500 I-K)LD:R 1HISU::KI~lEIXESNOT AMEM)EX'JIN)(R <br />Lombard, IL 60148 1'\ISl.R:RSNRH)NGCCM:RAGE <br />IIN::lUI'4:U NSl..flERA: ACE A. .1t:lrica11nsl..rcnle <br /> NSU'lER8: <br />[centerville Lions Club NSU'lERC: <br />~innesota INSURERO: <br /> NSU'lERE: <br />~ <br />Tl-E POLICIES OF INSURANCE LJSTB) BELOW HAVE BEEN lSSUEDlO Tl-E <br />ANYREOlJIREMENTTERM OR COI'<<lI1lONOF ANY CONTRACrOR 01HER DOClIMENTWITH RESPECT 10 WHICH THIS CERTFlCATE MAY BE ISSUED OR <br />I'Al'Yf'S{fANltE NSURANCEAffCRDEDBYll-EPOI..I::ESDElSCRIB8) I-EflEN LSSl.e.ECTlOALL 'Tl'E~ E>O.lJS06AN)CICN)(fD\I5CFSLOI <br />POUCES. AGGREGATE UMlTSstONN MAY HAVE BEEN REDUCED BY PAID CLANS. <br />1i.iR 1'IFECFNBl.IWCE FO.JC'(N..M!lER - 6'\CHocx:t.A'9<<:E LMI'S <br /> GENERAL L.IMIUTY S 1 <br /> - S <br /> X ~~lWlIJTY Fl'EIlAMAGECAnYane-> 1 <br /> I C1IWSMAOE 0 CXX1.R ..e:lexP(,AIya1e~ $ 1.QOC <br />A KXlG21731936 Q9U1t2005 (g)112OO6 ~&NNJU.R'( s 1 _. <br /> I-- GENl!IW.N3GNGATE <br /> S <br /> ~AOOREGAlELMT APPLES PER: PAODUCTS-CXM'J1OPNJiG S <br /> II PnLICV~ L1lC <br /> AUTOMOIILE UABILITY OCJlBIEDSNGlELMT S IrDJded i"IJttb:Ne <br /> I-- (PW 8llCldIIt) <br /> IH'( AUTO <br /> r-- ALLOM&lAlJTOS <br /> BOOLYINJURY <br /> f-- HXlG21731936 OOO1taDi mov.a:xJ6 (PWperscn) s <br /> SCtEDUB)AlJTOS <br />A "X HlB)NJTOS OJ\NI)PlJTO)r-vTCXMHD <br /> BalLVIN.lJRV <br /> ~ lP8r8llCidBnO S <br /> NClN-<l't'HODAlJTOS <br /> ~ <br /> f-- PRCPERrYIWW3E S <br /> (FW 8IlCidBnO <br /> CiA IAOE L.IA8IUTY AIJTO CH..Y -EANXIJENT S <br /> IWf AUTO IIOTCXM:RED cmERTlWf EA~ S <br /> r-- AUTOCH..Y: JtaO S <br /> EXCESS UA8lUTY EACH ClCX1lRAENCE S <br /> - DwrMilWJE IGGIB3AlE <br /> CXX1.R $ <br /> - NOT COVERED S <br /> - <br /> 0EDt.IC'IB-E S <br /> - S <br /> RETEN'I1CJ" $ ~I <br /> WORKERS COMPENSATION ""D I OTHER <br /> EMPLOYERS' UA8IUTY NOT CC1IIER3) E L EI'CH ACCIJENT $ <br /> EL I:llS6ASE-EA $ <br /> E L DISEASE-PaJCYLMT S <br />DE! CRIPT10N OF OPERATION8ILOCATlONSIVEHIClESlEXCLUSIONS ADDED BY ENDORSEIlEIITISPECIAL PROVISIONS <br /> <br />Provisions of the policy apply to the Centervllle Uons Club for their participation in a City Festival on August 3-7, 2006 (or any <br />ther dates during the policy period). <br /> <br />e City of Centerville is an additional insured, but only as respects liability arising out of the use of premises by the CentefVille <br />Lions Club and not out of the sole negligence of said additional insured. <br /> <br />J"E HCl..OER <br /> <br />ADDITIONAL INSURED; INSURER lETTER <br /> <br />City of Centerville <br />1880 Maine Street <br />Centervllle, MN 55038 <br /> <br />SHOULD NtV OF THE A8OIII! DDCIlISED I'OLIClES BI! CAHCB.ED IlEPORI! TIt!! <br />EXPIRATION DATETlIEREOF, TIE ISSUING COMPMY WILl. BNDeAVOR TO MAIL <br />~ DAYS WRIITEN NO'I1CETO TIE CBmFICATE HOUlI!R IWEO TOllIE 1.a:T, <br />IIUT' FAILURE TO 1lAlL8UCH NOTICE SHALL IIIPOSE NO OBIJGATlON OR IJABJU1Y <br />OF NtV KIND UPON THE COIIPNtV. lIS AGENTS OR REPRIi1IloIffA1IYES.. <br />~ <br /> <br />d~6.~ <br /> <br />John E. Adams, C.P.C.U. <br /> <br />ACGOc::oR'lORA.TrJN 19118 <br /> <br />3~ <br />