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�,,.--�.� LSBON-1 ,,,OP ID' <br /> ACOR�'l DA�imawDrrm�) <br /> �, CERTIFICATE OF LIABILITY INSURANCE p8/03l2018 <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 INSURAMCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING IN$URER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOL�ER. <br /> IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the poiicy(ies)must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the tarms and conditions of the policy,certain poiicies may require an endorsement. A statement on <br /> this certificate does not confer ri hts to Yhe certificate hoider in lieu of such endorsement s. <br /> PRODUCER 217-543-3'737 c cr����am W.Singer <br /> Singer Insurance Agency PHONE 21T-b43-3737 �� 217�43-3743 <br /> 108 South Vine Strest �ac,roo,en: (ac wo�: <br /> P.O.BOX 1H E�''�R�E : <br /> Arthur,iL 61911 <br /> William W.Singer INSURER S AFFpRDING COVERAGE NAIC# <br /> INSURERA:S ecial RiskofAmerica <br /> INSURED LSB Qne IflC. INSURER B: <br /> 129 S da�Cland <br /> decatur,IL 62521 INSIIRER C: <br /> INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CE TIFICATE NUMBER: REVI ION NUMBER: <br /> THiS IS TO CERTIFY THAT THE POLICIES OF INSURANCE US7ED BEIOW HAVE BEEN ISSUED TO THE 1NSURED NAMED ABOVE FQR THE POLICY PERIOD <br /> INDfCATED. NOlWiTHSTANDWG ANY REQUIREMENT,TERM OR CONDITION OF ANY CON7RACT OR OTHER DOCUMENT WITH RESPECT TO NMICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRiBED HEREIN IS SUB.IECT TO ALL THE 7ERMS, <br /> EXCIUSIONS ANO CONDITIONS OF SUCH POLICIES.LIMI?5 SHOWN MAY HAVE BEEN REpUCED BY PAID CLAIMS. <br /> INSR 7ypE OP iNSURANCE L1DL UBR ppUCY NUMBER PduCY EFF POLICY EXP UMITS <br /> A }( COMMERCIAI.GENERAI.IJABILITY �qCH OCCURRENCE g 1,000,000 <br /> GLAIMS-MAOE �OCCUR 10-2012-46�1 12/28/2017 12/2$/2018 p�qGE TO RENTE�n s _ �OQ,QQQ <br /> MEDEXP An one rson $ �,��� <br /> PERSOh1AL&ADV INJURY 5 �+QOO,OOO <br /> GEN'L ACyGREGATE LIMIT APPLIES PER: GENERALRGGREGATE g �,OOO,OOO <br /> POLICY�jE�7 �I.00 PRODUC7S-COMP/OPAGG 8 �,OOO,OOO <br /> OTH R: $ <br /> AUTOMOBIIE LIABILITY �e a�d��flS�NGLE L1MIT a <br /> ANY AUTO BODILY INJURY Per erson S <br /> OWNED SCHEpULED <br /> AUTO50NLY AUTOS BODILYIN.IURY Peraccidant S <br /> AUTOS ONLY AUTO�O�Y 1'�Oa E�Rd�e{AMAC,E $ <br /> 8 <br /> UMBRELLALJAB OCCUR EACH pCCURRENCE S <br /> EXCESS LIAB CLAIMS-MApE AGGREGATE S <br /> DED RETENTION3 <br /> WORKERS COMPENSATiON PER OTH- <br /> AND EMPLAYERS'LIABILITY Y�N T T � <br /> A�FFICER�iM�E��M6pER/F�CCLUDED?ECUTNE ❑ N�A E.L.EACHACCIDENT $ <br /> (Mandatory in NH) E.L DISEASE-EA EMPLOYE 8 <br /> tt yes,describe under <br /> DE5CRIPTION OF OPERATIONS IOw I -P LI Y LIM�T <br /> p Liquor Liability 1�-2011-226 12l28/2017 12/2812078 1,400,OD0 <br /> OESCRIPTION OF OPERATIONS i LOCATIONS i VEHICLES(ACORD 101,Additfonal Remarks Schedule,may be aNachetl if more space 3a repuired� <br /> LSB,Qne-Milliken Homecoming-Friday,10l5/2018 <br /> CERT FICAT H LD R � <br /> DECATUR <br /> SHOUID ANY OF THE ABOVE DESCRIBED POUCIES BE CANCEILED BEFORE <br /> THE EXPIRATiON DATE THEREpF, NOTICE WILL BE DELIVERED IN <br /> City nf Decatur ACCORDANCE WITH THE POLlCY PROVISION3. <br /> Inspections Department <br /> #1 Gary K.Anderson Plaza <br /> Decatur,IL 62523-1196 AUTHORIZED REPRESENTATIVH <br /> w�.�-:--- �----s��. <br /> ACORD 25(2016103) 01988-2015 ACORD CORPORATION. Aii rights reserved. <br /> � The ACfJRD name and logo are registerad marks af ACORD <br />