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LSBON-1 OP I <br /> TE(MMIDDIYYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE DA0411812018 <br /> 04/18!201$ <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, EXTEND OR ALTER 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(les)must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WANED,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 217-543-3737 c ACT William W.Singer <br /> Singer Insurance Agency PHONE217-543-3737 FAX 217-543-3743 <br /> 109 South Vine Street (A/C,No,Ext): (AIC,No <br /> P.O.Box 18 M I <br /> Arthur,IL 61911 <br /> William W.Singer INSURER(SI AFFORDING COVERAGE NAIC N <br /> INSURERA:Specialty Risk of America <br /> INSURED LSB One,Inc. INSURER B <br /> 129 S Oakland <br /> Decatur,IL 62521 INSURER C: <br /> INSURER D <br /> INSURER E: <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> ILTR NSR TYPE OF INSURANCE ODL U8R POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE E 1,000,000 <br /> CLAIMS-MADE rX�OCCUR 10-2012-4601 12/28/2017 12/28/2018 DAMAGE TO RENTED $ 100,000 <br /> MED EXP(Any onePerson) E 1,000 <br /> PERSONAL&ADV INJURY 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: <br /> S 11000,000 <br /> POLICY[:]JROTF_�LOC PRODUCTS <br /> -COMPLOPAGG E 1,000,000 <br /> OTHER: <br /> AUTOMOBILE LIABILITY C eMBMED SINGLE LIMIT 3 <br /> ANY AUTO BODILY INJURY(Per person) S <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS <br /> SSyyryE BODILY INJURY Per accident <br /> AUTOS ONLY AUTOS ONLDY FA ESR.ZI AMAGE $ <br /> UMBRELLA LtAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTIONS <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N T <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $0FFICER/MEMBER EXCLUDED? N I A <br /> 1n�andatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ <br /> A Liquor Liability 10-2011-226 12/28/2017 12/28/2018 1,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached N more space is required) <br /> Coverage for Bike Night on the following date:5/10/2018 in the 100 Block of <br /> South Oakland Avenue. <br /> CERTIFICATE HOLDER CANCELLATION <br /> DECATUR <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Ci of Decatur THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> City ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Inspections Department <br /> #1 Gary K.Anderson Plaza AUTHORIZED REPRESENTATIVE <br /> Decatur,IL 62623-1196 <br /> u)Zep --- <br /> ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />