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DATE IMIAODN YYI <br />ACOWL0 CERTIFICATE OF LIABILITY INSURANCE <br />DG10G12023 <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, EXTFN G OR At TER THE COVERAGE AFFORDED BY THE 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 have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER ROE; CONTACT Customer Care <br />We51 Bend Mutual Insurance Company P (866)92€-4244 UT{262) 365-2200 <br />1900 South 181h Avenue EMAIL ADDRESS: tustornercarewbmi.corn <br />West Bend WI 53095 INSURE B AFFORDING COVERAGE NAIC 0 <br />INSURER A: West Bend Mutual Insurance Company 15350 <br />INSURED INSURER B : <br />Cenleruilla Lions Club INSURER C <br />6849 CanterviPe Rd INSURER D <br />INSURER E : <br />Centerville MN 5508-9756 IR RER F . <br />COVERAGES CERTIFICATE NUMBER- CL236663290 REVISION NUMBER: <br />THIS IS TO CERTIFYTHAT THE POLICIES Or INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR. THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDINGANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY 8€ ISSUED OR MAY PERTAIN, THE WSURANCE AFFORDED BY THIF POLICIES DESCROED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />TYPE OF INSURANCE Sri POLICY NIUVIBER — — .JWat �Dr "YM A4MM)DfrffYj LIMITS <br />><. _ - -- -- E�ACHOCCUSRRENCE <br />Cr3MMERC IAL GENERA1. I.rABILITY I 1,0130.000 <br />i 100,00U <br />CLIi!MS-A7AUk. N OCCUR PREMISES.E�ccun S <br />A <br />GENL AGGREGAI"E LIMIT APPLIES PER: <br />POLICY ❑ JPIR?l Lac <br />OTHER; <br />AUTOMOB" LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY ALFTOS <br />KRM NON-OWAIED <br />AUTOS ONLY ALIT116ONLY <br />UMBRELLA LIAS OCCUR <br />EXCE$&LIAO CLWNSIv!RD= <br />DED I RETENTION ,$ <br />IL1EV i; XP l.An. orle pemon) $ Excluded <br />A175402 <br />0710712023 <br />OD0712024 <br />PERSON,, &AVV IYdURr <br />a 1,00,000 <br />GENERALAGGREGATE <br />5 2.00.000 <br />PRODUCTS - COW10pAGO <br />$ 2,000.000 <br />S <br />COM51NEDSINGLE LIMIT <br />E <br />BODILY INJURY (Pr Pwsm) <br />DWILY INJURY (Per SCdil" <br />PROPERTY DAMAGE <br />er <br />S <br />S <br />S <br />S <br />S <br />EACH OCCURRENCE <br />S <br />AGGREGATE <br />Is <br />3 <br />WORKERS COMPENSATHJN rtn urrt <br />ANT) EMPLOYERWLIABIUTY Y i N ER <br />ANY PRO PRI FTO RJPARTNE RlE?CEC UrIVE NIA E_. EACH ACCIDENT <br />OFFICEFUNCMRER EXCLUDED? <br />(Mandatory in NH) E L, DISEASE -EA EMPLOYEE <br />If re$, de90iee v:wrer <br />DESCR PTIDN DF CPERATIflNS Eei0w Ei. D SEAS -POLICY LIMIT S <br />— Common Cause Limit SI,D00,DDO <br />A Liquor Liatrlility Y A176406 07:0712023 07/07/2024 Aggregate Limit $1,OOO,000 <br />I <br />DESCRI15TION Or OPERATIONS 1 LOCATIONS I VEHICLES (AGGRO 10t Additional Ra arks Schedule, may be allaehed it more space Is required) <br />Certificate holder is listed as additional insured for liquor liability per form ONS0280. <br />UtH I II'lQA I h MULULK CANS tLLAI IIJN <br />SHOULD ANY OF THE ABOVE DESCRIBE. POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City ofCenterv:Ie ACCORDANCE WITH THE POLICY PROVISIONS <br />11380 Main St <br />AUT14ORIZED REPRESENTATIVE <br />. fl <br />Centerville MIN 55038jtl�gf{{lA^'tr <br />1988.2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />