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<br />ACORQ. CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) <br />10/08/2003 <br />PRODUCER (651)644-0311 FAX (651)641-8981 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Paul et/Sl ater. Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />2610 University Ave.. #200 {JeT o 9 2003 HOLDER. THlS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />St. Paul. MN 55114 <br /> INSURERS AFFORDING COVERAGE NA/C# <br />INSURED Sahawk. Inc. INSURER A: St. Paul Fire & Marine <br />DBA Sager.s Liquor INSURER B: Berkley Admrtnistrators <br />7093 20th Avenue South INSURER c: <br />Centerville, MN 55038-0000 INSURER 0: <br /> INSURER E: <br /> <br />COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BElOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINI <br /> ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR MlD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION UMlTS <br /> GENERAL UABlUTY RENL OF BK01283267 01/01/2004 01/01/2005 EACH OCCURRENCE $ 1,000 . 000 <br /> I-- <br /> X COMMERCIAL GENERAL UABIUlY DAMAGE TO RENTED $ 1.000.000 <br /> I ClAIMS MADE 00 OCCUR MED EXP (Anyone person) $ 10. 000 <br />A PERSONAL & AOV INJURY $ 1. 000 . 00Cl <br /> I-- 2.000.000 <br /> GENERAL AGGREGATE $ <br /> f-- 2.000.000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG $ <br /> n POLICY n ~rs: n LOC <br /> AUTOMOBILE UABlUTY COMBINED SINGLE LIMIT <br /> - (Ea accident) $ <br /> ANY AUTO' <br /> - <br /> ALL OWNED AUTOS BODILY INJURY <br /> - (Per person) $ <br /> SCHEDULED AUTOS <br /> - <br /> HIRED AUTOS BODILY INJURY <br /> - (Per accident) $ <br /> NON-OWNED AUTOS <br /> - -- <br /> - <br /> - PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE UABIUTY AUTO ONLY. EA ACCIDENT $ <br /> =1 ANY AUTO OTHER THAN EAACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESSIUMBRELLA UABIUTY EACH OCCURRENCE $ <br /> =:J OCCUR o ClAIMS MADE AGGREGATE $ <br /> $ <br /> ~ DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND WC220422701401 02/06/2003 02/06/2004 I T~~9T~JU-..1 10~- <br /> EMPLOYERS' UABJUTY E.L EACH ACCIDENT $ 100.00( <br />B ANY PROPRIETORIPARTNERlEXECUTIVE <br />OFFICERlMEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $ 100.00( <br /> ~o describe under E.L DISEASE. POLICY LIMIT $ 500.00( <br /> ECIAL PROVISIONS below <br /> O.j;HER . RENL OF BK01283267 01/01/2004 01/01/2005 CSL - $1.000.000 <br /> L quor Liability 0 <br />A Total Linrit - $2.000.000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHIClES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />~rovides Evidence of Insurance <br />~orkers Compensation evidence has been ordered and will follow directly from carrier <br /> <br />C <br /> <br /> <br />City of Centerville <br />1880 Main Street <br />Centerville. MN 55038 <br /> <br />C I <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />BUT FAILURE TO MAIL SUCH NonCE SHAI.L IMPOSE NO OBLIGATION OR UABJUTY <br />KIND UPON THE INSURER, ITS AGENTS REPRESENTATIVES. <br />REPRES AnVE <br /> <br />ACORD 25 (2001/08) <br /> <br />