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2003-11-12 CC Packet
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2003-11-12 CC Packet
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<br />ACOBlt CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYYYY) <br />10/13/2003 <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 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />St. Paul. MN 55114 <br /> INSURERS AFFORDING COVERAGE NAlC# <br />INSURED Wiseguys Pizza Inc INSURER 1.; TIG INSURANCE COMPANY <br />7095 20th Avenue S . INSURER B: St. Paul Fire & Marine <br />Centerville. MN 55038-0000 INSURER c: <br /> 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 MAYBE 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 />~4': ~P'.'l;~ TYPE OF INSURANCE POUCY; NUMBER POUCY EFFECTIVE POUCY EXPIRATION UMITS <br /> GENERAL UABlUTY BKOl466807 09/06/2003 09/06/2004 EACH OCCURRENCE $ 1.000.00(1 <br /> - <br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300 . 0001 <br /> I CLAIMS MADE 00 OCCUR MED EXP (Anyone person) $ 10.0001 <br />A PERSONAL & AOV INJURY $ 1.000.0001 <br /> - <br /> GENERAl AGGREGATE $ 2.000.00 <br /> - <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $ 2.000.00(1 <br /> I 'nPRQ- nLOC <br /> POLICY JECT <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> ~ (Ea accident) $ <br /> ANY AUTO' <br /> I-- <br /> AlL OWNED AUTOS BODILY INJURY <br /> ~ (Per person) $ <br /> SCHEDULED AUTOS ~ <br /> I-- <br /> HIRED AUTOS BODILY INJURY <br /> I-- (Per eccldent) $ <br /> NON-QWNED AUTOS "" <br /> I-- _.. <br /> I-- - PROPERTY DAMAGE $ Jf: <br /> (Par accident) <br /> GARAGE UABlUTY AUTO ONLY - EA ACCIDENT $ .M c~-:j '; <br /> R ANY AUTO f 'R~~ <br /> EAACC $ " ';'.~t.'7~ <br /> OTHER THAN , ;,~,11 <br /> AUTO ONLY: AGG $ , ; -;;~ {i, <br /> , .. I~ i'-t)'~\ <br /> EXCESSIUMBREllA UABIUTY EACH OCCURRENCE $ , i" .. <br /> tJ OCCUR o CLAIMS MADE AGGREGATE $ \ 11 <br /> ',' " U\~ ......~ <br /> , "f '~ <br /> $ i, i'X <br /> . I 'I.),,'" <br /> R DEDUCTIBLE $ '.. ' ",. \ <br /> . 1':,\, <br /> RETENTION Ii $ l;j}., "'1 <br /> WORKERS COMPENSATION AND 81040060 11/24/2002 11/24/2003 1-lXlt,~T~.m-..1 IO.m- II' .\~i ~~ \ <br /> Ijj;j, <br /> EMPLOYERS' LIABILITY E.L EACH ACCIDENT $ 1000U \t. <br />A ANY PROPRIETORIPARTNERfEXECUTIVE <br />OFFICERlMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE Ii 10000~ <br /> If yes, desalbe under E.L DISEASE - POLICY UMIT $ 5oo00Cl <br /> SPECIAL PROVISIONS below <br /> O~HER BKOl466807 09/06/2003 09/06/2004 $1.000.000 Ea Conmon Cause <br />B L quor Liability $2.000.000 Aggregate <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />'rovides Evidence of Insurance <br /> <br />I <br />:' i <br />~t <br />I <br /> <br />c <br /> <br /> <br /> <br />City of Centerville <br />1880 Main Street <br />Centerville. MN 55038 <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRAnON DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />-1:L DAYS WRITTEN NonCE TO THE CERTIRCATE HOLDER NAMED TO THE LEFT, <br />BUT FAILURE TO MAIL SUCH NonCE SHALL IMPOSE NO OBUGAnON OR LIABILITY <br />OF ANY KINO UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br />AUTHORIZED REPRES <br /> <br /> <br />ACORD 25 (2001/08) FAX: (651)429-8629 <br />
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