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DATE (MM/DD/YYYY)

CERTIFICATE OF LIABILITY INSURANCE 01/04/2019


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 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:
FIRST MID INSURANCE GROUP PHONE FAX
1520 CHARLESTON AVE (A/C, No, Ext): (217) 234-5577 (A/C, No): (217) 234-6493
E-MAIL
MATTOON, IL 61938-3960 ADDRESS:
astout@firstmid.com; llamb@firstmid.com
(217) 234-5577 INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A : United States Fire Insurance 21113


INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION (PURCHASING GROUP) AND INSURER B :
ITS PARTICIPATING MEMBERS:
INSURER C :
Mattoon Baseball Club, Inc INSURER D :
PO Box 1154
INSURER E :
Mattoon, IL 61938
INSURER F :

COVERAGES CERTIFICATE NUMBER: USP285799 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 ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS

GENERAL LIABILITY GENERAL AGGREGATE $2,000,000.00


X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG $2,000,000.00
CLAIMS-MADE X OCCUR PERSONAL & ADV INJURY $1,000,000.00
01/04/2019 01/04/2020
A SRPGAPML-101-0718 12:00 AM 12:01 AM
EACH OCCURRENCE $1,000,000.00
FIRE DAMAGE (Any one fire) $300,000.00
GEN'L AGGREGATE LIMIT APPLIES PER:
MED EXP (Any one person) $0.00
PRO-
X POLICY JECT LOC
COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY (Ea accident) $
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident) $
NON-OWNED PROPERTY DAMAGE
HIRED AUTO
AUTOS (Per accident) $

UMBRELLA LIAB OCCUR EACH OCCURRENCE $


EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $

EACH OCCURRENCE $0.00


GENERAL AGGREGATE $0.00
EACH OCCURRENCE $
GENERAL AGGREGATE $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Baseball

CERTIFICATE HOLDER CANCELLATION

Mattoon Baseball Club, Inc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
PO Box 1154 ACCORDANCE WITH THE POLICY PROVISIONS.
Mattoon, IL 61938
AUTHORIZED REPRESENTATIVE

First Mid Insurance Group

ACORD 25 (2010/05) v141120.001 © 1988-2010 ACORD CORPORATION. All rights reserved.


The ACORD name and logo are registered marks of ACORD
DATE (MM/DD/YYYY)
ADDITIONAL INTEREST SCHEDULE 01/04/2019
AGENCY CARRIER NAIC CODE

United States Fire Insurance Company 21113


POLICY NUMBER EFFECTIVE DATE NAMED INSURED(S)
SRPGAPML-101-0718/USP285799 01/04/2019 Mattoon Baseball Club, Inc
12:00 AM
ADDITIONAL INTEREST (Not all fields apply to all scenarios – provide only the necessary data)
INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER

ADDITIONAL Lake Land College


X INSURED
LOSS PAYEE LOCATION: BUILDING:

BEACH OF
WARRANTY
MORTGAGEE 5001 Lake Land Blvd VEHICLE: BOAT:

CO-OWNER OWNER Mattoon, IL 61938 AIRPORT: AIRCRAFT:


EMPLOYEE ITEM
REGISTRANT ITEM:
AS LESSOR CLASS:
LEASEBACK
TRUSTEE ITEM DESCRIPTION
OWNER
LIENHOLDER REFERENCE / LOAN #: INTEREST END DATE:

LIEN AMOUNT: PHONE (A/C, No, Ex): FAX (A/C, No):

REASON FOR INTEREST: E-MAIL ADDRESS:

INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER

ADDITIONAL City of Mattoon


X INSURED
LOSS PAYEE LOCATION: BUILDING:

BEACH OF
WARRANTY
MORTGAGEE 208 N 19th St VEHICLE: BOAT:

CO-OWNER OWNER Mattoon, IL 61938 AIRPORT: AIRCRAFT:


EMPLOYEE ITEM
REGISTRANT ITEM:
AS LESSOR CLASS:
LEASEBACK
TRUSTEE ITEM DESCRIPTION
OWNER
LIENHOLDER REFERENCE / LOAN #: INTEREST END DATE:

LIEN AMOUNT: PHONE (A/C, No, Ex): FAX (A/C, No):

REASON FOR INTEREST: E-MAIL ADDRESS:

INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER

ADDITIONAL Perfect Game, Inc Its Affiliates, subsidiaries and dbas


X INSURED
LOSS PAYEE LOCATION: BUILDING:

BEACH OF
WARRANTY
MORTGAGEE 850 Twixit Town Road NE VEHICLE: BOAT:

CO-OWNER OWNER Cedar Rapids, IA 52402 AIRPORT: AIRCRAFT:

EMPLOYEE ITEM
REGISTRANT ITEM:
AS LESSOR CLASS:
LEASEBACK
TRUSTEE ITEM DESCRIPTION
OWNER
LIENHOLDER REFERENCE / LOAN #: INTEREST END DATE:

LIEN AMOUNT: PHONE (A/C, No, Ex): FAX (A/C, No):

REASON FOR INTEREST: E-MAIL ADDRESS:

INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER

ADDITIONAL
X INSURED
LOSS PAYEE LOCATION: BUILDING:
Tony Harris
BEACH OF
WARRANTY
MORTGAGEE 1281 Hayes Ave VEHICLE: BOAT:

CO-OWNER OWNER Mattoon, IL 61938 AIRPORT: AIRCRAFT:


EMPLOYEE ITEM
REGISTRANT ITEM:
AS LESSOR CLASS:
LEASEBACK
TRUSTEE ITEM DESCRIPTION
OWNER
LIENHOLDER REFERENCE / LOAN #: INTEREST END DATE:

LIEN AMOUNT: PHONE (A/C, No, Ex): FAX (A/C, No):

REASON FOR INTEREST: E-MAIL ADDRESS:

INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER

ADDITIONAL
X INSURED
LOSS PAYEE LOCATION: BUILDING:

BEACH OF
MORTGAGEE VEHICLE: BOAT:
WARRANTY
CO-OWNER OWNER AIRPORT: AIRCRAFT:
EMPLOYEE ITEM
REGISTRANT ITEM:
AS LESSOR CLASS:
LEASEBACK
TRUSTEE ITEM DESCRIPTION
OWNER
LIENHOLDER REFERENCE / LOAN #: INTEREST END DATE:

LIEN AMOUNT: PHONE (A/C, No, Ex): FAX (A/C, No):

REASON FOR INTEREST: E-MAIL ADDRESS:

ACORD 25 (2010/05) v141120.001 © 1988-2010 ACORD CORPORATION. All rights reserved.


The ACORD name and logo are registered marks of ACORD
The above are added as additional insured but only with respect to liability arising out of operations of the named insured during the policy period.
ACORD 45 (2009/04) © 1993-2009 ACORD CORPORATION. All rights reserved.
=
The ACORD name and logo are registered marks of ACORD

ACORD 25 (2010/05) v141120.001 © 1988-2010 ACORD CORPORATION. All rights reserved.


The ACORD name and logo are registered marks of ACORD