2022-14 Ordinance Authorizing Consumption of Alcoholic Liquor Donnie's Homespun Pizza, Inc. Oakwood Business Association for Oakwood Block Pary Series, May 7 & August 20, 2022

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AC40 CERTIFICATE OF LIABILITY INSURANCE °"'E`NW°D 03/29/202222 THIS CERTIFICATE IS ISSUEDAS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOTAFFIRMATIVELY OR NEGATIVELYAMEND,EXTEND ORALTER 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 polity(las)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 certlffcate does not confer rights to the certificate holder In$leu of such endorsement(s). PRODUCER WMMr NAME Debbie Roy Dimond Bros.Insurance,LLC No E (217)543-3737 A1C No: (217)643-3743 109 South Dine Street ADDRESS: debble.roygdimondbros.com INSURERIS AFFORDING COVERAGE NAICM Arthur IL 61811 INSURERA: Special Insurance ServicesiSPRISKA 19780 INSURED INSURERS: Donna's Homespun Pizza,Inc. INSURERC: 126 S.Oakland INSURER 0: INSURER E.- Decatur :Decatur IL 62521 1 INSURERF• COVERAGES CERTIFICATE NUMBER: CL2232920375 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. NOTWITHSTANDINOANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAYBE 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. LTR TYPE OF INSURANCE i Eyy POLICYNUMSER UMlTB COMMERCIALOENERALUANU Y EACH OCCURRENCE f 1.000.000 UI:10 NI:N ICU CLAIMS•MADE ®OCCUR PREMIE n S 100,000 MEDEXP(AnVweOman) s 1.000 A 102020928 03101/2022 0310112023 PERW AL,,M lN.tURY s 1.000.000 OEMLAGGREGATE UMITAPPLIES PER; GENERALAGGREOATE f 2,000.000 PRO- POLICY❑JF-CrF� DU LOC PROCTS-COMPIOPAGO S 2,000,000 OTHER $ AUTOMOBa.EUABILITY COMBINEDSIN t s ANYAUTO BODILY INJURY Forpemon) S -.. OWNED SCHEDULED BODILY INJURY(For eoddsnp S AUTOS ONLY AUTOS PPERTYrAGE AUTOS ONLY AUTOS ONLYIRED INON-OWWED per S S UMBRELLA Ld1B HoccuR EACH OCCURRENCE S EXCESS LIAB CLAMS-MADE AGGREGATE S DED I I RETENTION i s WORKERS COMPENSATION MUTE AND EMPLOYERS UABILITY YIN E ANY PROPRIETORMARTNERIEXECUTIVEa NIA E.L.EACHACGDENT S OFFIGERIMEMBER EXC LUDED? (Mandatory to NN) El.DISEASE•EA EMPLOYEE S It Yes.desa the order DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s Each Common Cause $1,000,DOO A Liquor Liability 102020928 03/01/2022 03101/2023 Aggregate Limit $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS R VENICLES(ACORD 1101,Addillwal Remarks SCWUIM my beas hed N mom epee is requlmd) General certificate for proof of general liability and liquor Rabidly coverage to be extended to the Oakwood Black Party being held from 12:OD P.M.on Saturday May 7.2022 to 2:00 A.M.on Sunday May S.2022 and 12:00 P.M.on Saturday August,20.2022 to 2:00 A.M.on Sunday August 21,2022 on the street directly In front of Donnia's Homespun Pizza,126 S.Oakland,Decatur,IL. The street will be blocked off on S.Oakland between W.Wood SL&W. Main St.Decatur,IL for this event CERTIFICATE HOLDER CANCELLATION SHOULDANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.NOTICE WILL BE DELIVERED IN City of Decatur ACCORDANCE WITH THE POLICY PROVISIONS. #1 Gary K Anderson Plaza AUTNORIZEDREPRESENTATIVE .11,�t1r,• (� Q1o� Decatur IL 62523 �`��'�+�^-� y• "^.' I ®198&201SACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD nano and logo are registered marks ofACORD