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<br />~ <br />ACORD' <br /> <br /> <br />CERTIFICATE OF LIABILITY INSURANCE <br /> <br />DATE~ <br />12J28/2OC11 <br /> <br />PRODUCER <br />RH <br />333 E. Butterfield Road, 5th Roor <br />Lombard, IL 60148 <br />Phone: (800)316-6705 Fax: (630) 324-2779 <br />INSURED <br />Cenl8rvl1e Uona Club <br />MnneIota <br /> <br /> <br />I <br />ONLY AND CONFERS NO RIGHTS UPON THE CERnFlCATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> <br />INSURERS AFFORDING COVERAGE <br />INSURER k ACE American Insurance Company <br />INSURER B: <br />INSURER c: <br />INSURER 0: <br />INSURER E: <br /> <br />HAle 1# <br />22667 <br /> <br />COVERAGES <br /> <br />A <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOlWlTHSTANDING <br />ANY REQUIREMENT. TERM OR CONOmON 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 />LTR INSRIJ TYPE OF INSURANCE POlICY NUMBER ~ T <br /> <br />..!-ENERALLIABLITY HDOG21745662 & 0910112007 <br />X COMMERCIAL GENERAL LIABILITY CSZ0302505 <br />= :J CLAIMS MADE ~ OCCUR <br /> <br />DI'\I <br />DA <br />0910112008 <br /> <br />ON <br /> <br />LMTS <br /> <br />GEN\. AGGREGATE UMIT APPLIES PER: <br />I POLICY n 28r n LOC <br />AUTOII08IlE UABLITY <br /> <br />- <br /> <br />EACH OCCURRENCE I S <br />_fl~9 lea oc:cnncel S <br />MED EXP (M} one penon) S <br />PERSONAL & ADV INJURY S <br />GENERAL AGGREGATE S <br />PRODUCTS - COMPIOP AGO S <br />$ <br /> <br />1,000,000 <br />1,000,000 <br />1,000 <br />1,000,000 <br />2,000,000 <br />2,000,000 <br /> <br />- <br /> <br />A <br /> <br />ANY AUTO <br /> <br />HDOG21746682 & <br />CSZ0302505 <br /> <br />09/0112007 <br /> <br />09/0112008 <br /> <br />COMBINED SINGLE LIMIT <br />(Ea accldentl <br /> <br />S <br /> <br />INCLUDED <br /> <br />- <br /> <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />- <br /> <br />X HRED AUTOS <br /> <br />- <br /> <br />X NON-OWNED AUTOS <br /> <br />- <br /> <br />BODILY INJURY <br />(Per person) <br /> <br />s <br /> <br />IN ABOVE <br /> <br />- <br /> <br />BODILY INJURY <br />(Per aCCklent) <br /> <br />S <br /> <br />- <br /> <br />PROPERTY DAMAGE <br />(Per accident) <br /> <br />AUTO ONLY - EA ACClDefT <br />EAACC <br />AOO <br /> <br />$ <br /> <br />EACH OCCURRENCE <br />AGGREGATE <br /> <br />$ <br />, <br />I <br />S <br />S <br />S <br />. <br />s <br />I ~~raw-s I 10m <br />EL EACH ACCIDENT $ <br />EL. DISEASE - EA EMPlOYEE $ <br />EL. DISEASE - POlICY LNIT S <br /> <br />GARAGE UA8IJTY <br /> <br />~ANYAUTO <br /> <br />EXCEISJlMIREUA UABIJTY <br />:J OCCUR D ClAIMS MADE <br /> <br />OTHER THAN <br />AUTO ONL V: <br /> <br />--, DEDUCTIBLE <br />il RETENTION S <br />WORKERS CQtIJENSATION AND <br />a.L0YERS' UA8I.J1'Y <br />NlY PR~OAIPAR'1'tERIEXECl1 <br />0FFICSW.4EMBER EXClUDED? <br />ryes. dIscrIbe U1der <br />9P~ PROVISIONS below <br />OTHER <br /> <br />DEICRP110N OF OPERATIONS J LOCATIONS I VEHICLES I EXa.uIlONlADDED BY ~ I SPECIAL PROVISIONS <br />PravIIIonI GItha policy IppIy to th8..... InIur8d's p8ItIcIp8IIan In the I>>IawIng 8CMy ckftv the paIIcy period shown above: 2008 a.nteMIe ... Lno I.8k88 Uona Ice FIIhq ConI8It 2-e.GB or <br />2-18-08 <br />AnoIc8 Quty 8her11\" ca. . Included . an AdcIIIanIIlnalred(a). Idonly wIIh Nlpectto GeI8aI UIbIIIty ertaIng out d the UI8 of prMIIrIes by the Insand Ihawn 8bcM end not out tithe IOIe <br />nealaence fluid dIIIonallnllnd. <br />PROWlIONS f:E nE POUCV DO NOT APA.Y 10 TtE SALE OR SERVING OF ALCOHOLIC BEVERAGES <br /> <br />CERnFlCATE HOLDER <br /> <br />CANCELLATION <br />SHOUlD MY OF TIE ABOVE DESCRIBED POUCElBE CMCEUED IEFORE THE EXPItATION <br />DATE THEREOF, tHE ISIUItG INSURER WILL ENDEAVOR TO 11M. ~ DAYS WRITTEN <br /> <br />NOTICE TO 11E CERTIFICATE HOLDER NAIlED TO THE LEFT, BUT FAILURE TO DO 10 SHALL <br />WOSE NO OBLIGATION OR UABI.ITY OF AllY KIfD UPON TIE .SURER, rrs AGENTS OR <br />REPRESElfrATIVEI. <br />AUTHORIZED REPRESENTATIVE <br /> <br /> <br />CS> ACORD CORPORATION 1988 <br /> <br /> <br /> <br />41a- <br />