2022-28 Ordinance Authorizing Consumption of Alcoholic Liquor in Central Park Central Park Music & Arts Festival

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A ® DATE(MM/ Y) CERTIFICATE OF LIABILITY INSURANCE os/1o/20222022 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(ies)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 CONTACT Debbie Roy NAME: Dimond Bros.Insurance,LLC ?�C 0 Ext): (217)543-3737 ac,No): (217)543-3743 109 South Vine Street EMAIL debbie.roy@dimondbros.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Arthur IL 61911 INSURERA: Special Insurance Services/SPRISKA 19780 INSURED INSURER B: Security National Insurance Co. 19879 Donnie's Homespun Pizza,Inc. INSURER C: 126 S.Oakland INSURER D: INSURER E: Decatur IL 62521 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2261024340 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. INSR TYPE OF INSURANCEADUL POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MMIDD MMIDDMIYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENT 15 CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 1,000 A 102020928 03/01/2022 03/01/2023 PERSONAL&ADV INJURY $ 1.000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000,000 POLICY JECOT- F—]LOC PRODUCTS-COMP/OPAGG $ 2.000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLALIAS OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ETH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 100,000 B OFFICER/MEMBEREXCLUDED? M NIA SWC1377133 03/25/2022 03/25/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Each Common Cause $1,000,000 A Liquor Liability 102020928 03/01/2022 03/01/2023 Aggregate Limit $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Worker's Compensation Officer Exclusion:Neill Dresen is excluded from Work Comp. General Certificate for proof of Insurance for events being held on July 31,2022 from Noon to 8 P.M.,August 28,2022 from Noon to 8 P.M.,and Sept 25, 2022 from Noon to 8 P.M.and includes Certificate Holders DACVB&DAAC in addition to the City of Decatur. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF 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 AUTHORIZED REPRESENTATIVE Decatur IL 62523 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD