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AC" 0211712023 CERTIFICATE OF LIABILITY INSURANCE °ATE`MN"�' 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), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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). CONTACT Rep Customer Care PRODUCER NAME: West Bend Mutual Insurance Company PNu (866) 926 4244 I FArG, Na]: (262) 365-2200 — 1900 South 18th Avenue E-MAIL Acustomercare@wbmi.com DDRESS: West Bend WI 53095 INSURER(S) AFFORDING COVERAGE NAIC # i lNSURERA: West Bend Mutual Insurance Company 15350 INSURED Centerville Lions Club 7155 Brian Dr Hugo MN 55038-8729 INSURER B : INSURER C : INSURER D : INSURER E : rrnllCRAr_CS CFRTIFICATF NIIMRER- 19120 Master REVISION NUMBER: THIS ISTO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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. R I TYPE OF INSURANCE I INSD I sNwL, POLICY NUMBER MD POLICY MMrD POLICY EXP LIMITS A X COMMERCtALGENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 100,000 CLAIMS -MADE I -'I OCCUR PREMISES IFa occurrence."s S GEN"LAGGREGATE LIMIT APPLIES PER: PRO - POLICY D JECT F LOG OTHER: AUTOMOBILE LIABILITY ANY AUTO " OWNED SCHEDULED AUTOS ONLY 11 AUTOS HIRED AUTOS ONLY NON-OMFD AUTOS ONLY UMBRELLA LIAB OCCUR EXCESS LIAB I-1 CLAIMS -MADE A175402 4/22/2023 04/22/2023 ME) EXP Any one person) $ Excluded $ 1,000,000 PERSONAL &ADV INJURY GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMPIOPAGG i $ 2,000,000 COMBINED SINGLE LIMIT ,1Ea accident i $ BODILYINJURY (Per perscn) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE 'Per ac iden 1 $ $ DIED J I RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXFCUTIVE ❑ NIA E.L. EACH ACCIDENT .S OFFICER/MFMBER EXCLUDED? (Mandatory In NH) P L DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS belay _- E.L. DISEASE - POLICY LIMIT $ I C Common Limit 1,000,000 Liquor Liability q A175406 04122I2022 04122l2023 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) St Genevieve Parish Center is listed as Additional Insured under the General Liability as required by written contract per form WB1890 4122I23.- ULKII1-I1—AItMULUCK ^r•"�--^ �• City of Centerville SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1880 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Centerville, MN 55038 AUTHORIZED REPRESENTATIVE I U T9SS-LUIS At4VKU GVKYVKAI IUN. All rlgnis r'eserveu. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD