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<br />~ <br />ACORD- <br /> <br />CERTIFICATE OF LIABILITY INSURANCE <br /> <br /> <br />PRODUCER <br />HRH <br />333 E. Butterfield Road, 5th Roor <br />Lombard, IL 60 148 <br />Phone: (800)316-6705 Fax: (630) 324-2n9 <br /> <br />INSURED <br />Cent.ervflle Uons Club <br />Minnesota <br /> <br />INSURERS AFFORDING COVERAGE <br />INSURER A ACE American Insurance Company <br />INSURER 8: <br />INSURER c: <br />INSURER 0: <br />INSURER E: <br /> <br />NAle # <br />22667 <br /> <br />COVERAGES <br /> <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLlCY PERIOD INDICATED. NOTWITHSTANDING <br /> ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR =~ POUCY NUlatBER POlJCY EFFECTIVE Pg~~ =~ON UMJTS <br />LTR TYPE OF INSURANCE DATE ,MMlDD/YY) <br /> GENERAL UABlLITY HDOG21745662 & 09/01/2007 09/01/2008 EACH OCCURRENCE S 1,000,000 <br />A - =g~s (Ea occarence) <br /> X COMMERCIAL GENERAL LlABlUTY $ 1,000,000 <br /> - ~ CLAIMS MADE [8] OCCUR CSZ0302505 <br /> MED EX? (Any one person) $ 1,000 <br /> - <br /> PERSONAl & ADV INJURY S 1,000,000 <br /> - <br /> GENERAL AGGREGATE $ 2,000,000 <br /> - 2,000,000 <br /> GENt. AOOREGA TE UMIT APPUES PER: PROOUCTS.COM~OPAGG $ <br /> I POLICY n ~& nLOC $ <br /> AUTOMOBILE UABIUTY HDOG21745S62 & 09/01/2007 09/01/2008 COMBINED SINGLE LIMIT INCLUDED <br />A - S <br /> ANY AUTO CSZ0302505 (Ea acddent) <br /> - <br /> ALL O'NNEQ AUTOS BOOll Y INJURY IN ABOVE <br /> - $ <br /> SCHEDULED AUTOS (Per person) <br /> - <br /> X HIRED AUTOS 800lL Y INJURY <br /> - $ <br /> X NON-DWNED AUTOS (Per accident) <br /> - <br /> - PROPERTY DAMAGE S <br /> (Per accident) <br /> GARAGE UAB1UTY AUTO ONLY - EA ACCIDENT S <br /> ==l ANY AUTO OTHER THAN EA ACe s <br /> AUTO ONLY: AGG $ <br /> EXCESSIUMBREllA LIABIUTY EACH OCCURRENCE $ <br /> ~ OCCUR D ClA1MS MADE AGGREGATE $ <br /> S <br /> H DEDUCTIBLE S <br /> RETENTION S S <br /> WORKERS COMPENSATION AND I we STATU- I IOJr <br /> TORY LIMITS <br /> EMPLOYERS UABlUTY <br /> ANY PROPRIETORIPARTNERfEXECUTIVE E.L. EACH ACCIDENT $ <br /> OFFlCERlMEr.t3ER EXClUDED? E.L. DISEASE - EA EMPlOYEE $ <br /> tf yes, desaibe \I1der <br /> SPECIAL PROVISIONS below E.L. DISEASE - POUCY LIMIT S <br /> OTHER <br />DESCRPTlON OF OPERATIONS J LOCATIONS' VEHICLES I EXCLUSIONS ADDED BY ENDMSEMENT , SPECIAl PROVISIONS <br />ProvIsIons of the policy apply to the named Insured's participation In the foRewing actMly during the policy period shown above: 2008 CenteJvtUe and Uno Lakes lions Ice Fishing Contest 2-Q..08 or <br />2-16-{)8 <br />~ of Centervtlle Is Included as an AdditJonallnsured( s ~ but only with respect to General Uabfllty arising out of the use of premises by the Insured shown above and not out of the sole neglIgence of <br /> addftionallnsured <br />PROVlSION-S OF THE POUCY 00 NOT APPLY TO THE SALE OR SERVING OF ALCOHOUC BEVERAGES <br />CERTIFICATE HOLDER CANCELLATION <br /> <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POlICIES BE CANCEllED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING "SURER WILL ENDEAVOR TO MAIL ~ DAYS WRfTTEH <br /> <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAlWRE TO 00 SO SHAll <br />IMPOSE NO OBUGA TION OR UABUTY OF ANY KIND UPON THE INSURER. ITS AGENTS OR <br />REPRESENT ATIVE5. <br />AUTHORIZED REPRESENT AlIVE <br /> <br />ACORD 25 (2001/08) <br /> <br /> <br />@ACORD CORPORATION 1988 <br /> <br />d)41 <br />