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R�® CERTIFICATE OF LIABILITY INSURANCE OF ID CJ DATE(MM/DD/YYYY) <br /> YOUNG-1 12/13/12 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> Bennett & Shade Company HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR <br /> P O Box 858 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Decatur IL 62525-0858 <br /> Phone: 217-428-3411 Fax:217-428-5029 INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: New Hampshire Insurance Co. <br /> INSURER B: American Alternative Ins. Corp <br /> Young Men's Christian Assoc. <br /> Of Decatur INSURER C: <br /> 220 W McKinley Ave Ste A INSURER D: <br /> Decatur IL 6226 <br /> INSURER E: <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING <br /> ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> LTR INSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YYYY DATE MM/DD/YYYY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $1,000,000 <br /> A X X COMMERCIAL GENERAL LIABILITY 01-LX-9425873-8 10/01/12 10/01/13 PREMISES(Ea occurence) $100,000 <br /> CLAIMS MADE X❑OCCUR MED EXP(Any one person) $5,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GENERAL AGGREGATE s2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1,000,000 <br /> POLICY PRO LOC <br /> JECT <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT $1,000,000 <br /> A X ANY AUTO 01-LX-9425873-8 10/01/12 10/01/13 (Ea accident) <br /> ALL OWNED AUTOS BODILY INJURY <br /> SCHEDULED AUTOS (Per person) $ <br /> HIRED AUTOS BODILY INJURY <br /> NON-OWNED AUTOS (Per accident) $ <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE s2,000,000 <br /> A X OCCUR 71 CLAIMS MADE 01-UD-0587890-7 10/01/12 10/01/13 AGGREGATE s2,000,000 <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION X TORY LIMITS ER <br /> AND EMPLOYERS'LIABILITY <br /> B ANYR/MEMBEREXCLUDEDXECUTIV� WC 4 17767404 10/01/12 10/01/13 E.L.EACH ACCIDENT $500,000 <br /> OFFIC(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 <br /> If yes,describe under <br /> SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT I$500,000 <br /> OTHER <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br /> RE:Road Race, 12/31/12; The Certificate holder and The State of IL shall be <br /> an Additional Insured in accordance with all the terms,conditions and <br /> limitations of the policy and then only with respect to liability caused by <br /> the negligent acts or omissions of the named insured. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> CITYOFD DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL <br /> City of Decatur IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR <br /> Attn: Linda Swartz <br /> #1 Gary Anderson Plaza REPRESENTATIVES. <br /> Decatur IL 62523 AUTHORIZED REPRESENTATIVE <br /> Wesley P Shade <br /> ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />