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<br />. . '.. <br /> <br />ACORDCERTIFICATE OF LIABILITY INSURANCE DATE(MvtDQ'VY) <br /> .. June 16. 2006 <br />PROOUCER (630)324-2500 FAX (630)324-2501 Q-LY /IH)~NORlGHTSLf'C:I\Il't-ECER'l'FrA1E <br />T. J. Adams Group, a HUb Rogal & Hobbs Company H:lLDER. lHISCERTFIC'A'TEDCES NOT At.tENDEXTEN:>OR <br />333 E. Butterfield Rd., Suite 500 <br />Lombard, IL 60148 NSURERSAFFCR:lNGcx::NERAGE <br />NSUREO NSURERk ACEAmerIcan Ir1surar1re <br /> NSURERB: <br />Centerville Lions Club INSURER C: <br />Minnesota INSURER D: <br /> INSURSRE: <br />IWY'REQUIREMENT TERM OR CONDrTlONOF IWf CONTRACT OR OlliER OOCUMENTWITH RESPECT TO WHICH THIS CERTlFICATE MAY BE ISSUED OR <br />MAYPeRrANlHE NSURANCEAFl'ORDEDBYlHEFCl.JCESDESCRBED H:REN SSUB.ECTTOALL. THETEFlMS, EXClUSlONSANOCQ\lDI1DNSOFsu:H <br />POLICIES. AGGREGATE UMrrs SHCM'N MAY HAVE BEEN REDUCED BY PAlO CLAIMS. <br />~ 1'IPEOFNSl.W.NCE PClJCVI'UIEIflR -- 1iACH0CClR'lE1<<:E WITS <br /> ~ERAL LIABILITY S .. <br /> ~ cc:Mvt:fOOl..~1.WlIJTV ~DAAW3EfInIQ'l8h) $ 1 <br /> ~ CU>/MSA.WlE 0 oca..R M3) ElCPflnlcre peISQl\} $ 1 rYY' <br /> - HXlG21731lm 09t01f2005 0910112006 PERSI:JolAL&KN.1II.IlRY $ 1 000000 <br />A f <br /> i-- ., 000 000 <br /> GeNERALAGGREGAlE $ <br /> i-- PRODUCTS-COMPKlF'AGG $ ., 000 000 <br /> GENl. AGGREGAlE UMIT APPUES PER: <br /> h .....L~Vn~ n,nr. <br /> AUTOMOBiLe LJABlUTY CCMlINEDSINGl.ELMr S Induded InAbcve <br /> i-- (Per scdlIert) <br /> - PIN AUTO <br /> AU. ov.NeOAUTOS BOOLY INJURY S <br /> - HDOG21731936 CB01l2OO5 00{)112!XJ6 (Per per;an) <br /> SCHEOI.UOAUTOS <br />A ~ HR3lAlJlOS OJ\A'oE)PUTtl3t-1JTcx:>vER:D <br /> BODLY/NJURY s <br /> ~ NCJN.OWNEOAU'TOS (Per~ <br /> - PROPERTY DAMAGE S <br /> (Per lICCIdenI) <br /> oA WJE LIABILITY AUTO ClNLY. EAACCIlENT $ <br /> IWY AUTO NJrCCNBti) OTHER THAN EAACC $ <br /> - AUTO ON.. Y: <br /> 1>00 S <br /> exCESS LlASIUN EACH ClCCURRENCE $ <br /> - DClAIMSMAllE ~'TE S <br /> OCCUR <br /> '-- NOT COVERED $ <br /> ~ <br /> CEOUCI1BLE S <br /> ~ S <br /> REI'8II11ON$ <br /> WORKERS COMPENSATION AND I we STATU- I I OTHER <br /> I!MPLOYERS' lIABILITY NOTCCNERED E L EACH ACCICENT S <br /> E LClISIOASE. EABvI'LO'l'EE S <br /> E L. DISEASE -POUCY UMIT S <br /> <br />DESCRIPTION OP OPERATIONSlLOCATIONSIVEHICL&81EXCLU810NS ADOED BY INOOR81MINTISPICIAL PROVI810NS <br /> <br />Provisions of the polley apply to the Centervllle Lions Club for their participation In a City Festival on August 3-7. 2006 (or any <br />other dates during the policy period). <br />The City of Centerville is an additional insured, but only as respects liability arising out of the use of premises by the Centerville <br />lions Club and not out of the sole negligence of said additional Insured. <br />CERllFICATE Ha.DER I I ADDITIONAL INSURED; INSURER LeTTER <br /> SHOULD IWY OF THE ABOVE DESCRIBED POUCIES BE CANCELeD BEFORE THE <br /> EXPlRA110N DATE THEREOF, THE I$SUING COMPANY WILL ENDEAVOR TO MAIL <br />City of Centervi/le ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOlDER NAMED TO THe LEFT, <br />1880 Maine Street BUT FAILURE TO MAIl SUCH NOTlCE SHALL IMPOSE NO OBUGAl1ON OR UASlLITY <br />Centervllle, MN 55038 OF NlY KIND UPON THE COMPNlY.ITS AGENTS OR REPRnI!NTAl1VU. <br /> ATlVlf d~E.~ <br /> John E. AdaIm, C.P.C.U. <br />" <br /> <br />.AOORDCORf'ORAlION 1SB8 <br /> <br />11~' <br />