2014-37 AUTHORIZING CONSUMPTION OF ALCOHOLIC LIQUOR ON PUBLIC RIGHT-OF-WAY AND IN CENTRAL PARK - DECATUR CELEBRATION

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DEC1100 OP ID: RT ACRO- CERTIFICATE OF LIABILITY INSURAN E FDAT0 /YYYY) 07//15/16114 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 COVE"E AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE I SUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SU ROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this ce ificate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER CONTACT P PRO bbard Insurance 8 Bonds 217-877-3344 NAME. Rand Taylor 1090 South Route 51,PO Box 14 217-877-0795 a/co"o Ell:217-877-3344 FAX No): 217-877-0795 Forsyth,IL 62535-0014 E-MAIL Kevin J.Breheny ss:rtaylor@jlhubbard.com INSURERS AFFORDING VERAGE NAIC# INSURER A:West Bend Mutual Insurance 15350 INSURED Decatur Celebration Inc INSURER B:RSUI Insurance Compa iy 160 East Main Suite#200 INSURER C:Riverport Insurance Co Tipany Decatur,IL 62526 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVI ION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NA4ED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCU14ENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HER IN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPE OF INSURANCE A D POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X X NSB071175909 07/22/14 07/22/15 PREMI ES Ea occurrence $ 200,00 CLAIMS-MADE I A I OCCUR MED E P(Any one person) $ Exclude PERSC NAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PROD CTS-COMP/OP AGG $ 2,000,00 POLICY PRoi L71 LOC $ AUTOMOBILE LIABILITY 7BODIL�INJURY ED SINGLE LIMIT ent 1,000,00 A ANY AUTO NSB071175908 07/22/14 07/22/15 (Per person) $ ALL OWNED SCHEDULED BODIL INJURY Per accident $ AUTOS AUTOS ( ) X HIRED AUTOS X NON-OWNED PROPE TY DAMAGE AUTOS Per ac ident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 A EXCESS LIAB CLAIMS-MADE NUB077157808 07/22/14 07/22/15 AGGRE ATE $ 1,000,00 DED X RETENTION$ -0- $ WORKERS COMPENSATION XM OTH- AND EMPLOYERS'LIABILnY C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/" WC128701389303 07/22/14 07/22/15 E.L.EA HACCIDENT $ 500,00 OFFICERIMEMBER EXCLUDED? Fy] N/A (Mandatory In NH) E.L.DI SE-EA EMPLOYEE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DI ASE-POLICY LIMIT $ 500,00 B Liquor Liability NBA00075500 07/22/14 07/22/15 Limit 1,000,00 A Rented Equipment NSB071175908 07/22/14 07/22/15 Limit 120,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Re: Decatur Celebration 2013 The City of Decatur is named as additional insured under the General Liability and Liquor Liability; subject to written contract. A Waiver of Subrogation is awarded to the City of Decatur under the General Liability; subject to written contract. CERTIFICATE HOLDER CANCELLATION 1001187 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. 1001187 AUTHORIZED REPRESENTATIVE Barry Leonard #1 G ,.� #1 Gary K Anderson Plaza Decatur IL 62523 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD