R2017-140 Temporary Closing of State Rights-of-Way 2 Miles to Miles Crown 5K

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YOUNMEN-01 CTEW LL ACOR© DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 11/08/2017 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 OR 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 the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If 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 We. Cirystl Teweli J.L.Hubbard Insurance and Bonds PHONE 1090 South Route 51 AIC,No,Ext):(217)877-3344 3226 FAX No:(217)877-0795 Forsyth,IL 62535 E M IL .cteweil 'lhubbard.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Beazley Beach Response INSURED INSURER s:West Bend Mutual Insurance Com an 15350 Young Men's Christian Associat Matt Whitehead INSURER C 220 W McKinley Ave INSURER D: Decatur,IL 62526 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR NSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP IYYYYI LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE F–]OCCUR X VISCC1170401 10/01/2017 10/01/2018DAMAGE TORENTED occurrence) $ X Cyber Liab MED EXP(Any oneperson) $ PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 POLICY 0 jPCT F—]LOC PRODUCTS-COMPIOP AGG $ OTHER: B AUTOMOBILE LIABILITY COMtEa_aBINEDSINGLE LIMIT 1,000,000 X ANY AUTO 2133802 10/01/2017 10/01/2018 BODILY INJURY(Perperson) $ OWNED AUTOS ONLY AO E EEpp BODILY INJURY Per accident $ AUTOS ONLY AUTNLY PeOacl�t AMAGE $ $ B X UMaRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE 2133802 10/01/2017 10/01/2018 AGGREGATE $ DED RETENTIONS Aggregate $ 5,000,000 B WORKERS COMPENSATION X PER 07H- AND EMPLOYERS'LIABILITY T ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 2133804 10/01/2017 10/01/2018 E.L.EACH ACCIDENT 500,000 MandaFFICEr Mgt'EXCLUDED? ❑N N/A 500,000 tory In ME)' E.L.DISEASE-EA EMPLOYE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space is required) RE:Proof of coverage for 2 Miles to Miles event-New Years Eve event 12131117; The City of Decatur and the State of Illinois are named as Additional insureds under the Genera(Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Decatur THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Debbie Bright ACCORDANCE WITH THE POLICY PROVISIONS. 1 Gary Anderson Plaza Decaur,IL 62523 AUTHORIZED REPRESENTATIVE ..,.R-� s '- , ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD