2017-22 Consumption of Alcoholic Liquor 2100 Block E Cantrell Street Wild Dog Saloon Bike Night

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AM30 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 4/24/2017 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(fes)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). PRODUCER CONTACT NAME: Bret Dixon Insurance PHONE (888)249-0035 F/C N :(888)349-0035 403 S. Prairie St. E-MAIL S:mail@bretdixonins ADDRES .com PO Box 205 INSURERS AFFORDING COVERAGE NAIC a Bo IL 62010-0205 INSURER A:LlO d'a INSSUREDURED INSURER S:Stone ate Insurance Managers, Inc. 14012 Wild Dog Saloon Incorporated, INSURER C: DBA: Wild Dog Saloon INSURER D: 815 S 22nd Street INSURER E: Decatur IL 62521 INSURER F: COVERAGES CERTIFICATE NUMBER CL1742411244 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. WSR ADDL SUER LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP LIMBS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A CLAIMS-MADE OCCUR DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ X IL11701704 5/25/2017 5/26/2017 MED EXP(Any one person) $ 0 PERSONAL&ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑PRO- ❑ JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO Not with this agency BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Par accident) $ HIRED AUTOS AUTOS NED APROPERTY DAMAGE AUTOS Per ident $ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE Not with this agency AGGREGATE g DED RETENTION$ $ WORKERS COMPENSATION PER O H- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR(PARTNER/EXECUTIVE Under separate cover E.L.EACH ACCIDENT $__ OFFICERrMEMBFA EXCLUDED? ❑N I A (Mandatory in Nnd E.L.DISEASE-EA EMPLOYE $ If yeund descri s, be er DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ B Liquor Liability :7 01333 8/23/2016 8/23/2017 Each Common Cause $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additlonal Remarks Schedule,may be attached R more space Is required) The aforementioned coverage applies to the insured's participation in the event on 5/25/2017 from 5p-lip at 815 S 22nd Street in Decatur, IL 62521 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Decatur THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1 Gary R Anderson Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Decatur, IL 62523 AUTHORIZED REPRESENTATIVE Bret Dixon/KMV 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2ouot)