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<br />; ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMlDDIYY) <br />TII 06/12/2002 <br /> PRODUCER (952)893-9218 FAX (952)893-9402 ' . _ l::i 1::i::iUcD A::i A IVI~ J I CI'\ UI" IIUN <br /> CORPORATE 4 INS AG~NCY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 7220 METRO BOULEVARD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> EDINA, MN 55439-2133 INSURERS AFFORDING COVERAGE <br /> INSURED INSURER A: General Star Indemnity <br />Centerville Lions Club INSURER B: <br />7389 Old Mill Road INSURER C: <br />Centerville, MN 55038 INSURER D: <br />I INSURER E: <br /> <br />COVERAGES <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD" INDICATED. NOlWlTHSTANDING <br />ANY REQUIREMENT, TERM OR CONDmON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTlACATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDmONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />~ TYPE OF INSURANCE POLICY NUMBER "DATE (MMlDDIYY) OA'TE (MMIODIYY) LIMITS <br /> GENERAL UABIUTY EACH OCCURRENCE $ <br /> - <br /> COMMERCIAL GENERAL L1ABIUTY FIRE DAMAGE (Anyone fire) $ <br /> r ClAIMS MADE 0 OCCUR MED EXP (Anyone person) $ <br /> PERSONAL & ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ <br /> h 'nPRO- n <br /> POLICY JECT LOC <br /> AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT <br /> ~ $ <br /> ANY AUTO (Ee accident) <br />. I--- <br /> ALL OWNED AUTOS BODILY INJURY <br /> ~ $ <br /> SCHEDULED AUTOS (Per person) <br /> I--- <br /> HIRED AUTOS BODILY INJURY <br /> I--- $ <br /> NON-OWNED AUTOS (Per accident) <br /> I--- <br /> I--- THIS INSURANCE IS ISSL ED PURSUAN TO PROPERTY DAMAGE $ <br /> TJ..'~ C!IICDI : tC I 1I..1J::~ II\.I~II"" , ..,,..c: (Per accident) <br /> GARAGE UABIUTY ACT. THE INSURER IS AN LIGIBLE SUR LUS AUTO ONLY - EA ACCIDENT $ <br /> R ANY AUTO LINES INSURER BUT IS NOT OTHER' VISE OTHER THAN EA ACC $ <br /> LICENSED BY THE STATE OF MINNES01 A. IN AUTO ONLY: AGG $ <br /> EXCE$S LIABIUTY ....l'\vE; vr , r II UF EACH OCCURRENCE $ <br /> D OCCUR o ClAIMS MADE IS NOT GUARANTEED. AGGREGATE $ <br /> SURPLUS LINES TAX $ <br /> R DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND I TORY UMITS I -r~ <br /> EMPLOYERS' UABIUTY E.L EACH ACCIDENT $ <br /> E.L DISEASE - EA EMPLOYEE $ <br /> E.L DISEASE - POLICY UMIT $ ! <br /> OTHER IMA574028 06/30/2002 06/30/2003 $1,000,000 each common cause , <br />A Liquor Liability $1,000,000 aggregate <br /> 'i",. <br /> i <br />DESCRIPTION OF OPERATlONSlLOCATlONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS <br /> " <br />CERTIFICATE HOLDER I I ADDmONAL INSURED; INSURER LETTER: CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE <br /> EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL <br /> --10....- DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br /> Centerville Lions Club BUT FA/WRE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATlON OR UABIUTY <br /> 7389 Old Mill Road OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. i <br /> Centerville, MN 55038 AUTHORIZED REPRESENTATIVE ~?X.~ i <br /> - <br /> Jane Johnson/MB : <br />Al,;URD :l5-::i (1/91) c 11llSlS <br />