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<br />ACORQ,
<br />
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />
<br />THE POLICIES OF INSUPANCE LISTED BELOW HAVE BEEN ISSUED TD THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDIN
<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 />POUCIES. AGGREGATE LIMiTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR DD'U TYPe OF rNSURANCE POLICY NUMBER POLICY EFFECTIVE PQ!'!g,Y,~~~~t~!9.N LIMITS
<br /> ! GENERAL LIABIliTY 0966107 06/19/2004 06/19/2005 EACH OCCURRENCE , 1,000,000
<br /> r-x- COf\U.1ERCIAl GENERAL LIABILITY ~~~~~~~J9<:~ENTED , 50,000
<br /> I I CLAlr"lS r1ADE [8] OCCUR MEO EXP (Anyone person) ,
<br />A PERsmJAl & ADV INJURY , 1,000,000
<br /> f- GENERAL AGGREGATE , 2,000,000
<br /> GEN'l AGGREGATE LIMIT APPLIES PER: PRODUCTS. CaMP/Of:> AGG , 2,000,000
<br /> hi 'fxf:RC III
<br /> POLICY X JEer LOC
<br /> ~TOM08ILE LIABILITY CA62644572 06/19/2004 06/19/2005 COMBH,IED SINGLE LIMIT
<br /> ,
<br /> ~ ANY A.UTO IEaElccidefll) 1,000,000
<br /> I ALL O'N:1EI) AUTOS
<br /> C BODILY INJURY ,
<br /> SCHEDULED AUTCS {Per person}
<br />B
<br /> 'X HIRED l'UTCS eODltY INJURY
<br /> 7 ,
<br /> NON-OVlNED AUT(JS (Peraccidenl}
<br /> f-'-'-
<br /> ,"- PROPERTY DAMAGE 5
<br /> {Per accident)
<br /> RAGE LI~BIlIYY AUTO OI~L Y - fA ACCIDENT ,
<br /> ANY AUTQ OTHER THAN EA ACC ,
<br /> AUTO OrK y, AGG 5
<br /> tKJESS/UM3REllA LIABILITY AAU70762404 06/19/2004 06/19/2005 EACH O(~CURRENCE 5 4,000,000
<br /> [X OCCUF: D CLAIMS MADE AGGREGATE , 4,000,000
<br />C i 5
<br /> J;:i DEDlCTIe.lE 5
<br /> r X RETEiHlCJN S 10,00( 5
<br /> WORKERS COMPENSATfON AND 1.,';;rc~T~"::;:31 [OJb"
<br /> EMPLOYERS' UABlllTY RY 11
<br /> ANY?ROPR\ETOR:PARTr'IERif:XECUTIVE E.L EACH ACCIDENT S
<br /> OFFICER/MEMBER EXCLUOE(I? EL. DISI"ASE - EA EMPLOYE ,
<br /> If yes, describe ur.der EL. DISEASE - POUCY LIMIT ,
<br /> SPECIAL PROVI~,IO~IS be'ow
<br /> OTH':R
<br />b~ESCRIPT10N OF OPERt-TIONS I LOCATJONS J VEHICLES J EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RECEIVED
<br />ate: August 6, 200A
<br />~ddjtional InsJred: Festival of Lakes, City of Centerville JUl 23 ZOO4
<br />~ite: Festival grounds, Laurie LaMotte Memorial Park
<br />
<br />PRODUCER (440)248-4711
<br />Britton-Gallagher and
<br />6240 50M Center Rd.
<br />Cleveland, OH 44139
<br />
<br />FAX (440)24&-5406
<br />Associates, Inc.
<br />
<br />INSURED Americana Fi,reworks Disp ay Co.
<br />P.O.' Box 0456,
<br />Excelsicr, MN 55331
<br />
<br />COVERAGES
<br />
<br />CERTIFiCATE HOLDER
<br />
<br />Festival of Lakes, City of Centerville
<br />1880 Main Street
<br />Centerville, ,.,IN 55038
<br />
<br />ACORD 25 (2001iD8)
<br />
<br />DATE (MMfDDIYYYY)
<br />07/19/2004
<br />
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />
<br />,
<br />
<br />INSURERS AFFORDING COVERAGE
<br />INSURER A: Lexington Insurance CO
<br />INSURERS: Granite State Insurance CO.
<br />INSURERC, Axis Specialty Ins Company
<br />INSURER D:
<br />INSURER E:
<br />
<br />NAIC#
<br />
<br />CA"'CEllATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICJES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, THE ISSUtNG ~,':5URER WILL ENDEAVOR TO MAil
<br />~ DAYS WRITTEN NOTICE TO THE. CERTIFICATE HOLDER NAMED TO THE lEFT,
<br />BUT FAILURE TO MAil SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR lIJ>,E!.ILlTY
<br />OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
<br />AUTHORIZED REPRESENTATIVE 4!f,d-i2.J~.>
<br />IHarold Rindels/SLD /1-
<br />
<br />I
<br />
<br />@ACORDCORPORATION 1988
<br />
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