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AV <br /> . ..h a .� �ga�:, �;� u�� <br /> �e ra <br /> X <br /> Name and Address of Agency Name and Address of Member <br /> Park District Risk Management Agency Decatur Park District <br /> 2033 Burlington Avenue 620 E. Riverside Drive <br /> Lisle, IL 60532-1646 Decatur, IL 62521 <br /> (630)769-0332 <br /> cqppl <br /> qveragw�. <br /> The Park District Risk Management Agency(PDRMA)is an intergovernmental self-insurance and risk management pool established under t <br /> Constitution and the statutes of the State of Illinois to provide coverage for its members against certain claims and losses. Each member of <br /> PDRIVIA is entitled to the scope and amounts of coverage set forth below. In addition,PDRIVIA may extend the same scope of coverage to r <br /> members. However,any coverage extended to a non-member is subject to all of the terms,conditions,exclusions,and amendments which <br /> applicable to the members. <br /> The above named entity is a member in good standing of the Park District Risk Management Agency. The scope of coverage provided by& <br /> Agency may,however,be revised at any time by the actions of PDRIVIA's governing body. As of the date this certificate is issued,the <br /> information set out below accurately reflects the scope of coverage established for the current coverage year. <br /> Scope of Coverage Policy Number Coverage Dates Limits Each Occurrence <br /> General Liability Bodily Injury and Property $1,000,000 <br /> x commercial general liability L010113 01/01/2013- Damage Combined <br /> x occurrence 12/31/2013 <br /> Personal Injury $1,000,000 <br /> Automobile Liability GEM-0003-A10001 01/01/2013- Bodily Injury and Property $1,000,000 <br /> x any auto 12/31/2013 Damage Combined <br /> Workers'Compensation WC010113 01/01/2013- Statutory <br /> 12/31/2013 <br /> Employer's Liability GEM-0003-A10001 01/01/2013- $3,000,000 <br /> 12/31/2013 <br /> Property <br /> P0700113 01/01/2013- <br /> 12/31/2013 <br /> 1/01/2013-12/31/2013 <br /> Other <br /> 01/01/2013- <br /> 12/31/2013 <br /> on`6 <br /> f O'pe"rciti!6"'ni/Ldbations/Vehidlet;/Spec!41,ltemi;,,,',:.: <br /> The City of Decatur, Illinois and the State of Illinois is/are additionally insured for Decatur Park District's use of roads for the <br /> Firecracker Road Run on July 4, 2013. <br /> Coverage is for general liability with respect to the operations of the Decatur Park District. Additional insured coverage shall <br /> not apply to any liability resulting from the certificate holder's own negligence or the negligence of its servants agents or <br /> employees. <br /> Certificate Holder Date Issued: 05/14/2013 <br /> City of Decatur and State of Illinois <br /> One Gary K. Anderson Plaza <br /> Decatur, IL 62523 Authorized Representative <br />