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AC40 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/25/2025 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(ies)must have ADDITIONAL INSURED provisions or 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 Customer CareNAME: West Bend Insurance Company PHONE (866) 926-4244 FAX (262)365-2200A/C No Ext: FAX No 1900 South 18th Avenue E-MAIL customercare@wbmi.comADDRESS: West Bend WI 53095 INSURERS)AFFORDING COVERAGE NAIC# INSURERA: West Bend Insurance Company 15350 INSURED INSURER B: Hugo Lions Club INSURER C: PO Box 321 INSURER D INSURER E- Hugo MN 55038-0321 INSURER F COVERAGES CERTIFICATE NUMBER: CL25112581727 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IPOLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDY EFF MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE Fx_]OCCUR PREMISES jEaoccurrenrei $ 100,000 MED EXP(Any one person) $ Excluded A Y A108567 01/01/2026 01/01/2027 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER:GENERAL AGGREGATE $ 2,000,000 X POLICY EJ JECT PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accidentli UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB HCLAIMS-MADE AGGREGATE DED I I RETENTION$ 1 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Liquor Liability Each Common Cause 1,000,000 A Y A108575 01/01/2026 01/01/2027 'Aggregate limit 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Certificate holder is listed as additional insured for General Liability per form WB1890 and Liquor Liability per farm NS0280. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Hugo ACCORDANCE WITH THE POLICY PROVISIONS. 14669 Fitzgerald Ave N AUTHORIZED REPRESENTATIVE Hugo MN 55038 Ro" / ,--,, 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD