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DECAARE-01 DJRAINEY
<br /> CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY).
<br /> 717/2014
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON T HE CERTIFICATE HOLDER.THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAG E AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISS JING INSURER(S),AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBF OGATION IS WAIVED,subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certifiRate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME:
<br /> Arthur J.Gallagher Risk Management Services,Inc, pyp�E FAx - -----_..__._._..__._...._........_
<br /> 101 S.Main Street,Suite 200 tAtc�No,E911:(217)423-2345 [A+c,.No1;(217)428-0865
<br /> Decatur,IL 62523 E-MAIL -
<br /> INSURE
<br /> iasURERa-Frankenmuth Mutual III i _ ...__..
<br /> INSURER(S)AFFORDING COV AGE NAIC a
<br /> __ _
<br /> nee Company, 11 3986
<br /> INSURED INSURER B
<br /> Decatur Area Arts Council INSURER C;
<br /> 125 N.Water ENSURER D: --
<br /> Decatur,IL 62523
<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 DOCUM NT 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 /> ENSR'' .............11'�06LT3UBR............. ...�..�._..pOLICY EFF .POLICY EXP
<br /> LTR: TYPE OF INSURANCE I POLICY NUMBER I MMlOD/YYYY,I MMIDDiYYYY C LIMITS
<br /> A COMMERCIAL GENERAL LIABILITY j EACH OCCURRENCE S 1,000,00
<br /> anlMs-I+ADE I OCCUR i CPP6217831 04!01!2014 04/01/2015 PAGE o RENTED
<br /> t........ PREMISE (Ea occurrence) ,$
<br /> ..............__--.---------...._._....__-. ! MEDEXP Anyone Person) S 5,00
<br /> PERSONA $ADV INJURYS 1,000,00
<br /> GEN'L AGGREGATE LIMIT APPLIES PER, GENERAL24GGREGATE $ 2,000,000
<br /> PRO- ..._._.._ ._ _
<br /> POI ICY „ !ECT LOC ' PRODUCTS•COMP/OP AGG S 2,000,00
<br /> o1HeN
<br /> AUTOMOBILE LIABILITY COMOINEE SINGLE LIMIT $ 1,000,000
<br /> (Ea acmd 1)
<br /> A
<br /> ANY AU TO BA6217831 04/01/2014 04101/2015 BODILY IN URY(Po=person) S
<br /> ' ALL OWNED '.SCHEDULED
<br /> _AUTOS IAUTOS i BODILY IN URY(Per accident) S
<br /> X HIREOAUTOS x AUTOS Fpor i DAMAGE $----_—----_- -
<br /> f ur acud_a t
<br /> —.S
<br /> X UMBRELLA LIAR X `OCCUR
<br /> A CLAIMS-MADE i CPP6217831 04f01/2014 04/01f2415 EACH OCCURRENCE $ 1,000,00
<br /> , EXCESS LIAR I AGGREGATE $
<br /> 0
<br /> OE❑ X(RETENTION$ A re a e -
<br /> g9 9 S 1,000,000
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABILITY STAT TE.,. _ ER.___
<br /> A 'ANY PROP RIE TORIPARTNERIEXECUTIVE YIN WC6217831 04/01/2014 04/01/2015 E L.EACH CCIDENT $ 500,00
<br /> OFFICERIMEMBER EXCLUDED' ❑;NTA .. .,
<br /> (Mandatory in NH) DISEASE-EA EMPLOYEE $ 500,00
<br /> I! es d"T"IOe undo/P£ftATtONS bel
<br /> E L DISEA B E POLICY LIMIT S 500,00
<br /> DESCRIPTION OF pow
<br /> A Business Owners Pack CPP6217831 04101/2014 04/0112015 OCC&A g 1,000,00
<br /> I
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached It more space Is requlred)
<br /> City of Decatur#1 Gary K Anderson Plaza,Decatur,IL 62523 is named as additional Insured for the liability evidenced abo a arising from the operations of the
<br /> named insured for the event on September 27th,2014-Brew He He at 126 N.Water St.,Decatur,IL 62523
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Decatur THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> #1 Gary K.Anderson Plaza ACCORDANCE WITH THE POLICY PROVISI DNS.
<br /> Decatur,IL 62523
<br /> AUTHORIZED REPRESENTATIVE
<br /> �Ax �r.L.✓� I
<br /> ©1988-2014 ACORD CORP RATION. All rights reserved.
<br /> ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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