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�•�� DEC1100 OP ID:RT <br /> ACORO� DATE(MMIDDMlYY) <br /> `� CERTIFICATE OF LIABILITY INSURANCE 04/2212016 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certiflcate holder is an ADDITIONAL INSURED,the polfcy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s. <br /> PRODUCER CONTACT <br /> w,ME: Rand Ta lor <br /> J.L.Hubbard Insurance&Bonds PHONE Fnx <br /> 1090 South Route 51,PO Box 14 ac No e�c:217-877-3344 ac No:217-877-0795 <br /> Forsyth,IL 62535-0014 �o�ss:rta lor 'Ihubbard.com <br /> Kevin J.Breheny <br /> INSURER S AFFORDIN6 COVERAGE NAIC# <br /> wsuReR n:West Bend Mutual Insurance 15350 <br /> INSURED DecaturCelebration Inc INSURERB: <br /> 160 East Main Suite#200 <br /> Decatur,IL 62526 �S�ERC: <br /> INSURER D: <br /> MSURER 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 DOCUMENT WffH RESPECT TO V1RiICH 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 /> INSR TypE OF WSURANCE POLICY E F POLICY EXP �� <br /> LTR POLICY NUMBER MMIDDIYYYY MMlDDlYYYY <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 'I,OOO,OO <br /> CLAIMS-MADE �OCCUR X 071175909 06/04/2016 07/22/2016 pREMISES Ea occurrence S 2�0,�� <br /> MED EXP(Any one person) 5 EXCIUd@ <br /> PERSONAL&ADV INJURY S 'I�OOO,OO <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 2,000,00 <br /> POLICY�jE�T �LOC PRODUCTS•COMPbP AGG S 2,000,00 <br /> OTHER: I 5 <br /> AUTOMOBILE LIABILJTY COMBINED SINGLE UA�9T I S <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per personJ S <br /> ALl OWNEO SCHEDULED BOpILY INJURY(Per acddent) S <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE 5 <br /> HIREOAUTOS AUTOS Peracdden <br /> S <br /> UMBRELLA LIAB OCCUR EACH OCCIXtRENCE S <br /> EXCESS LtA6 CLAIMS-MADE AGGREGATE S <br /> DED RETENTION 5 5 <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIHBIL(TY Y�N STATUTE ER <br /> _............._. <br /> ANY PROPRIETOR/PARiNER/EXECUTiVE El.EACH ACCIOENT 5 <br /> OFFICERMIEMBER IXCLUDED4 ❑ N/A <br /> (Mandatory in NH) E.L.qSEASE-EA EMPLOYEE S <br /> DESCRIPTION OF OPERATIONS below EL.pSEASE-POLICY LIMIT S <br /> q Liquor Liability 145840 06/04/2016 06/05/2016 Limit 1,000,00 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Addftional Remarks Schad�de,may be atbehed if more apace is required) <br /> Re:French Fried SK Event on 06/04/16�See Remarks for Route Information) <br /> City of Decatur is named as additional msured under the General Liability; <br /> su6ject to written contract. <br /> CERTIFICATE HOLDER CANCELLATION <br /> CIT0006 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> City of Decatur ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 1 Gary K Anderson Plaza <br /> Decatur,IL 62523 AUTHOR¢EDREPRESENTATNE <br /> �-�f.f►4��►�1���+ <br /> �/ <br /> O 1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />