2012-43 AUTHORIZING CONSUMPTION OF ALCOHOLIC LIQUOR ON PUBLIC RIGHT-OF-WAY AND IN CENTRAL PARK - DECATUR CELEBRATION

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�+1 DEC1100 OP ID: RT DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 06/29/12 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(les) must 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). PRODUCERCONTACT 217-877-3344 NAME; Randy Taylor J.L.Hubbard Insurance&Bonds 217-877-0795 PHONE 217-877-3344 aC 1090 South Route 51,PO Box 14 (PTCOIL,Ext No): 217-877-0795 Forsyth, IL 62535-0014 Kevin J. Breheny ADDRIEss: rtaylor@jlhubbard.com INSURERS AFFORDING COVERAGE NAIC It INSURER A:West Bend Mutual Insurance 15350 INSURED Decatur Celebration Inc INSURER B:Riverport Insurance Company 160 East Main Suite#200 INSURER C:RSUI Indemnity Company Decatur,IL 62526 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 INSURANCE A DL B POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 AMAGE TO R TED A X COMMERCIAL GENERAL LIABILITY X NSB071175906 07/22/12 07/22/13 PREMISES Ea occurrence) $ 200,00 CLAIMS-MADE I A I OCCUR MED EXP(Any one person) $ Excluded PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY 7 PRO LOC $ AUTOMOBILE LIABILITY COMaBINEDaccident SINGLE LIMIT $ 1,000,000 E A ANY AUTO NSB071175906 07/22/12 07/22/13 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE NUB077157806 07/22/12 07/22/13 AGGREGATE $ 1,000,00 DED I X I RETENTION$ -0- $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY ORY LIMIT ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WC128701389301 07/22/12 07/22/13 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERAI IONS below i E.L.DISEASE-POLICY LIMIT $ 500,000 C Liquor Liability X NBA00044000 07/22/12 07/22/13 Limit 1,000,000 A Rented Equipment NSB071175906 07/22/12 07/22/13 Limit 60,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Re: Use of Central Park's Memorial Bank Shell City of Decatur is named as additional insured under the General Liability On a primary basis and additional insureds under the Liquor Liability; both of which are subject to written contract. CERTIFICATE HOLDER CANCELLATION CEL0058 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 Decatur,IL 62523 AUTHORIZED REPRESENTATIVE Kevin J. Breheny ©1988-2010 ACORD CORPORATION. All r,' reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD