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R DATE IYMID DnTM . cc�Ra CERTIFICATE OF LIABILITY INSURANCE 0614512023 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 DR 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 tho certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. it 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 'I- 'ahn Adams DSP Insurance Services, Inc. 1900 E. Golf Road. Suite 650 Schaumburg, IL 60173 INSURED Centerville Lions - 5M7 Centerville Minnesota PHONE .P.'_ h 1-800-3116-6705 RDDRIFs5: iionsclubs@dspins.com INSURER S AFFORDING COVERAGE INSURFRA ACE American insurance Compan-. INSURER B . INSURER C INSURER D INSURER E rAx AX Noi: $47-934-6186 r1AVF0AP_CS4 r".CI7TIFIrATI= NIIURPQI RFViS:1CIN NUMefR, NAIC N 22667 THIS IS TO CERTIFY THAT THE POLiCIFS OF INSURANCE LIS1€D BELOW HAVE OEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR 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. LIMI1 S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN SR I PDI ICY EFF POLICY EXP LTR TYPE OF INSVRAriCL POLICY NUMBER rMlrlRyDlYYTY DIYYYYi ' LwnTc A GENERAL LIABILITY EACH OCCUFQIzNCt S 1,000,000 X CowzRCUa.GrzwA LLImwmy PREtAISE cxwrrence- S 1,DO6+OOU CLAIMS -MADE � QCCUFz rAED E7L4s e:,.One:. y rJ,t HDO 647352241 04/0112022 09/01i2023 T,I]QD°t?00 X r N m d Insured Pt:R50NALa ADV IhLXW s Is $2,000,000 GENERAL AGGREGATE S 10,000.ODO GENL AGGREGATE LoArr APPLIES PER PRODUCTS • +CONINOP AGG s 2.0UD OM x POLICY PRd LOC f l� AUTOM013ILELIABIL17Y �OaI°ON �IGLELMT ANY AUTO BODILY INJURY (Per person) $ AU. OWNED SCHEDULED ISA H10761220 09/01/2022 09/01/2023 BODILYKAJRY(Per avdenit S AUTOS _ .AUTOS HIHkUALITCI5 NJN-OwW4EO x. AUT09Slr,kIlt PROPERTY DAMAGE S UNINE LLA LtA9 OCCAM EACH OCCURRENOE S EXCESS LLAB CLAI E S DED RETENTIONS `+ WORK ERSCOMPENSATI()N I VYC5TnTU• O1H• AND EMPLOYERS't IA91LITY YIN - - — ANY PROPRIETORT'+4RTHERIEXEL-UlIVE € L EACH S OFFICERWEMBER EXCLUDED,) n NIA, {Mwidawq In N4) E L DISEASE - EA EN4'LOYtI S r. yy�eess nc+,crrht canner OESGRI?TIOH OF OPERATIONS omm E L DISEASE - POLICY LIMIT I S DE$CRIPTION OF OPERATIONS r LOCATIONS) V€tMCLES (Artach ArOR0 Tot Addilransl Remoks Schedule, it mare spasm is rirprMad) Provisions of the policy apply to the named insureds participation in the follov ing activity during the pObLy period shown above: Fete des Laos, July 14.162023 The following persons or organizations granting use of real property, induding structures thereon are included as Additional Insured(s), but only with respect to General Liability arising out of the use of promises by the inF tired shown above and not out of the sole negligence of said additional insured. "` City of Centerville — PROVISIONS OF THE POLICY ba NOT APPLY TO THE SALE OR SERVING OF ALCOHOLIC BEVERAGES Pr_93"Flt%ATP Writ M012 C_aNC'1=1 I A"I"InNI SHOULD ANY CF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Citgy of Centerville Q1 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Main tercet Centerville Minnesota 5503$ ACCORDANCE WITH THE: POLICY PROVISIONS. AUTHORIZEDREPRESENTATIVE � J I988•1U1b AC:UKU C:UKFUMA I IVII. Ali rignis reserves. ACORD 25 (2016ID3) The ACORD name and logo are registered marks of ACORD