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ACORD ,,,,, CERTIFICATE OF LIABILITY INSURANCE DATE 03/(MM/DDOY) <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOR�MAT OI <br /> *lent Group ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> P.O.BOX 1910 HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR <br /> CARMEL,IN 46082-1910 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW <br /> DENTON K FLAHAULT,AAI.CIC <br /> Phone No.317-817-5000 Fax No. 317-817-5151 COMPANIES AFFORDING COVERAGE <br /> INSURED: Kiwanis Intl,All Clubs and Their Members- COMPANY <br /> Insured Local Club: A First Specialty Insurance Company <br /> CNAME:LUB i I Ul e R LAKE / I LJ\�) S COMPANY <br /> B <br /> CLUB 1l <br /> ADDRESS: V Ac IC S 14 A 86 C COMPANY <br /> ?-9 IQ PANAVIC w BI- VD. C <br /> E vE 2 e -rT, wA 8zo3 COMPANY <br /> D <br /> COVERAGES <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, <br /> NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE <br /> 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 /> CO <br /> LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY LIMITS <br /> DATE(MM/DD/YY) EXPIRATION DATE <br /> (MM!DD/YY) <br /> GENERAL LIABILITY GENERAL AGGREGATE $ 2,000,000 <br /> A X COMMERCIAL GENERAL LIABILITY IRG475471 11101/02 11/01/03 PRODUCTS-COMP/OP AGG _ $ 2,000,000_ <br /> CLAIMS MADE X OCCUR PERSONAL&ADV INJURY $ 1,000,000 <br /> OWNERS&CONTRACTOR'S PROT EACH OCCURRENCE $1,000,000 <br /> X AGG PER DISTRICT FIRE DAMAGE(Any one fire) $ 50,000 <br /> MED EXP(Any one person) $ <br /> AUTOMOBILE LIABILITY <br /> ANY AUTO COMBINED SINGLE LIMIT $ 1,000,000 <br /> ALL OWNED AUTOS <br /> SCHEDULED AUTOS BODILY INJURY <br /> A X HIRED AUTOS IRG475471 11101/02 11/01/03 (Per person) $ <br /> A X NON-OWNED AUTOS -' <br /> X $3,000,000 Aggregate <br /> PROPERTY DAMAGE $ <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> ANY AUTO OTHER THAN AUTO ONLY $ <br /> _ EACH ACCIDENT $ <br /> AGGREGATE $ <br /> EXCESS LIABILITY EACH OCCURRENCE $ <br /> UMBRELLA FORM AGGREGATE - $ <br /> OTHER THAN UMBRELLA FORM $ <br /> WORKERS COMPENSATION AND WC STATU- 0TH- $ <br /> TORYLIMITS ER <br /> EMPLOYER'S LIABILITY $ <br /> EL EACH ACCIDENT $ <br /> INCL ' <br /> THE PROPRIETORS/ EL DISEASE•POLICY LIMIIT $ <br /> PARTNERS/EXECUTIVE EXCL <br /> OFFICERS ARE EL DISEASE-EA EMPLOYEE $ <br /> DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/SPECIAL ITEMS <br /> 5-7-(0- C Ft 4 elA p i o-.) S ii I P /3 8 © C c o,< 0A-1-:- o,v m A 3c f H 't 31 Sr -&VE.,cr 'To 13 E <br /> HELQ Ir.) YI CITy or G- VC2C, 77 wE• rr ueE PA-12KIn1GLo , <br /> CERTIFICATE HOLDER <br /> x.0j igg w z:.. :40:; y ..tip,. `M <br /> Name• Q. \`t"`{ o F C E C rr ,�..,,;4. i r.: .�:�;o > , <br /> SHOULD ANr o�THE ABOVE oasclMv POLICIES�eANeatatf vows THE <br /> EXPIRATION OAT!TNtRIEOP.IMF IiAINO COMPANY WILL ENDEAVOR TO MM. <br /> Atte: 1' A t2 y P E Q rH 0 L - • 19 O►Y1 W en-nol Non=To TNt CQTMfcAT7 NDIDQR W WRD TO nut LBR, <br /> M7t PAR.XMtt TO ir MMS MO <br /> Address: Z9 30 cr V►'1 07z- & oP Aur RTND OR <br /> AUTI.bII® ,, <br /> E V (2- _ ,- 4 • <br /> ,:� <br /> I • t AA" c c <br /> Deg t . . <br /> ACORD 25-S(1/95) '� sAim - ;macotffici5lrwe[ sssy <br /> 17 <br />