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,�..--.� �.sBor�-� i � B <br /> ACORL7� DATE tMNUDDtYYYY) <br /> �..,, CERTIFiCATE OF LIABILITY INSURANCE 43/05/2418 <br /> THIS CERl7FICATE JS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TNE CERTIPIGATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMA7IYELY OR NEGATtVELY AMEND, EXTEND OR ALTER THE GOVERAGE AFFOROER BY THE POLICIES <br /> BEIOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CqN7RAC7 BETWEEN TWE ISSUING lNSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE GER7IFICATE HOLOER. <br /> IMPORTANT: If the cerkificate hoider is an ADDITfONAL INSURED,the po(icy(ies)must have ADDITIONAL INSURED provisions or be endorsed. <br /> tf SUBROGATION IS WAIVED,subject to the tertns and conditions of the policy,certain policies may require an endorsement A statement on <br /> this certificate does nat corifer ri hts to the certificate holder in Ifeu of such endorsement s. <br /> PRO�IICER 297-543-3737 co acr William W.Singer <br /> Singer Insurance Agency PHOFlE 217-543-8737 F� 217-543-3743 <br /> 109 South Vine Street tnrc,No,Erzt): NC,No1: <br /> P.O.8ox 18 � <br /> Arthur,IL 61911 <br /> WPiliam W.Singer �Nsux 5 AFFORDING COVERAGE NAIC# <br /> uusuR�rsa:S ecial RiskofAmerica <br /> i D INSUREIi 8: <br /> 129 S Oa lanil INSURER C: <br /> Decatur,�L 62529 <br /> INSURER D: <br /> INSURER E: <br /> IPISUREi2 F- <br /> COVERAGES GERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS(S TO CERTIFY THAT THE POLICIES OF IN5URANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED WAMEp ABOVE FOR THE POLICY PERIQD <br /> INDlCATED. N07WITHSTANDING ANY REQUIREMENT,7ERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THfS <br /> CERTIFiCATE MAY BE l55UED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCfES DESCRIBED HEREIN IS SUBJECT TO AlL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OP SUCH POIICIES.LIMITS SHOVIM MAY HAVE BEEN REDUCED BY PAID CLAIM5. <br /> INSR TypE pF INSURANCE DDL UBR ppl,��y NUMBER P��Y�F P���P LlMITS <br /> A X COMMERpAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 <br /> qA�Ms-MADE ❑X oCCUR 10-2012-4601 72/28/2018 1212$/2019 �AMAGETOR�ENTEO $ 100,040 <br /> MEDEXP M ar�e rson 5 1,000 <br /> PERSONAL&ADVINJURY S �,OOO,OOO <br /> GEN'LAGGREGATEUMITAPPUESPER: GENERAIAGGREGATE S �.00O,OOO <br /> POLICY❑jE�T �LOC PRpDUCTS-CAMPlOPAGG S ��000,000 <br /> H R: 5 <br /> AUTOMOBILE UA8ILITY CAM81�,N�O SINCdLE UMIT S <br /> AMY AUTO BpDIIY iNJURY Per ersan 5 <br /> OWNEO SCHEDULED <br /> AUTOS ONIY AUi'OS 80DILY INJURY PerBtadent 5 <br /> AU705 ONLY AU7�03 ONLY PPet�a�dent�AGE $ <br /> UMBRELLA 11A6 OCCUR EACH OCCURRENCE 5 <br /> EXCESS UAB CLAIMS-MADE AGGREGATE 5 <br /> DED RETENTION S <br /> WdRKERS COMPENSATION PEAT OTH- <br /> AND EMPLOYERS'LtAB1LiiY y f N — <br /> AOF�FICE�fi�Mg�E�RIXCLUDEERD7 ECUTNE ❑ w�A E.L.EACH ACCIDENT S _ <br /> �Mandatory in NH) El.DISEASE-EA EMPLOYE 5 <br /> Ifyes.desc�ibe under <br /> DESCRIPTION OF PE TiONS below E. OISEASE-POUCY UMIT 5 <br /> q Liquor Liability 10-2011-226 12/28/2018 12128i2419 1,000,000 <br /> DESCWPTiON OF pPERATONS I IOCAitONS!1/EFi1CLES(ACORD 10i,AddiYionai Remarka Schedute,may be attaehetl If more spaee fs reqWred) <br /> LSB,(7ne�Coverage for 5 events in 2019:3/16/19-LSB Run. <br /> Block Parties held on the foliowing dates•5/4/2Q19,6/28/2019,8/24/2019, <br /> and 8/28/2019 in the 100 Block of South Oakland Avenue. <br /> CERTIFICATE HOLDER CANCELLATION <br /> CIDE001 <br /> SHOULD ANY OF THE ABQVE DESCRiBED PQLICIE$BE CANCELLED BEFORE <br /> CI Of Decatur TNE EXPIRATION DATE THEREOF, N077CE WILL BE DEUVERED IN <br /> tY ACCQRDANCE WITH THE POUCY PROVISIbNS. <br /> 1 Gary K.Anderson Plaza <br /> Decatur,IL 62523-1196 <br /> AUTHORRED REPRESEryTATIVE <br /> t�J�.e�-%-- �----S<-�-z,-- <br /> ACORD 25(2016/03) C�11988-2U15 AGORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />