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<br />.D$te~ 02/~2/06 7i~: lO:eS AM To: '651-407-0364
<br />
<br />. 651-641-8981
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<br />Page: "01-001
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<br />I 'T I
<br />A~OF{Q~~ CERTIFICATE OF LIABILITY INSURANCE DATE (MMJOOIYY'YY)
<br /> 2/22/2006
<br /> p~.couceR FAX (651) 641-8981 THIS CERnFICATE IS ISSUED AS A MAlTER OF INFORMATION
<br /> Paulet/Slate.r, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTlFICA TE
<br /> HOLDER. THIS CERTIFICATE DOES NOT AfI1EHD, EXTE~D 01(
<br /> 2610 U:oiversity' Ave. I '200 AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br /> .~ !:..::-:~l l'.lN 55J.14 INSURERS AFFORDING COVERAGE NAle #
<br /> UoISUReO ;NSURER .t..: Safeco InsuraDce
<br /> Kelly's Korner 1no. , Sahwak of 1..- IDe INSL:RER B. Berkley AdministratoJ:s
<br /> dba: Sagers Bar-n-Grill H~SliRER C'
<br /> ., 0 9 8 CeDte.l.'Vil1.e ad : NSURER 0:
<br /> .-
<br /> Ceu'te.Lville MN 550380000 INSURER E:
<br />
<br />COVERAGES
<br />
<br />T~E POLICIES OF iNSURANCE LISTED BeLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER~OD II\iCICATEO. l'tJOT\l\JITHSTAND!NG ,A.f~"
<br />RE(}UtREMEUT. TE~M OR CONDITlor'J OF ANY COf\JTRACT OR OTHER DOCUMENT WiTH R'ESPECT TO WHICH THIS CERTIFICA'Te MAY BE ISSUED OR M.AY PERTAIN.
<br />TH r-: INSIJ~ANCE .!Y=FOROED BY. THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND COftjOITIONS OF SUCH POLICIES.
<br />AGGREGATE LIMITS SHOW~J MAY HAVE BEEN 'REDUCED BY PAID CLAIMS.
<br />It-lSR ~DD'L TiP! 01: INSURANCE POLlCV NUMBER POLICY J;FJ~J:mVE POLICY EXPIRATION LIMITS
<br />LTR fNSRD CATE .(MMIDDIVY) DA TE (MMIDD/VV)
<br /> I GENER4L LlABU..ITY I EACH CCCUF:RE:NCE $
<br /> I
<br /> , ~ ~~~1~i~~~1i~:V~i~~~~r, (e:;
<br /> _ t:". l".lj';/~r~C~AL -;'~i"~:f\-At..' LiP.S!!.!T: .~
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<br /> 1 ~ ~:lA"""I''^"1E . 0 Yr"'lR ~i;=~.: ::}!~ ,;',rv (;n~ (,9r;l.;n:i .~
<br /> , I " , ,. .. u ~.' .. '.. - ' . -
<br /> i ~~JA.L ~',!. D'\.. I;'~~ 'f
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<br /> -1 . ;~Et'iE~.AL ;'!;GREG..;.'r~ i
<br /> ~!'..'" ':'~';' E (. I. r::: L :J:T A :"PU ES PE::i ~RODUCiS - ('0~~Hi)P A::<:, $
<br /> " ," nr::9l;' nl("~
<br /> i :-').'.1 . Jt.....T _'JI_
<br /> I l!-~~M O&IlE lIA81L In' COMG:j'JEC. SiNG-'_E utJIT
<br /> ! (Ea dc\.:oint) $
<br /> I .~ ."'\N Y .....J"~ ()
<br /> j ~ ~L~. '-I'('~NED A.Ul I)':; ~CViL y IN,Juh~ .
<br /> ,F.;r P€f~.(..n} $
<br /> ....- :.CHED'-LEC1 ':).'''; ;'( "~ -
<br /> ! -- :-~, '~)E~' AUT') :.. 60Dl:..':' Ir~JUR'r'
<br /> O:~r ,,((idem: t:
<br /> n.; ~'.I...jl.'\'f\iE :::1 AU flY::;
<br /> ; 10--
<br /> I 1--- ~~.---..~ PR(IPERT\' DAM/<...E ~..'t
<br /> ! ~(:H acc,o.s.'1(
<br /> ';.AAA~E LfAIU.fN p.UTl.) ON~.';' . EI"', .1, :/.:!C.ENT f.
<br /> : ==t ';', , .\.[(. $
<br /> OTYFR T~AN E~ ACe
<br /> ~.l11 :) ,)t. j L Y . AI:oG $
<br /> ! r::K~SS.t1JMS".ELLA LIABILITY EACH O(;('URPEN'':'E $
<br /> -',
<br /> ~ ,:..;((::A~ o -L ',:-./1-- f 1~D:- AGI..H~EGA TE $
<br /> '.., 10\. I I.:;' , . .:.
<br /> i
<br /> .-
<br /> t ==1""'" . ,('TIF l C f
<br /> L_L" .. _ ._
<br /> !
<br /> , .:',:= iF;-iT; I ~.~': $ ~
<br /> ! WUR;.<E;;;CO\4PENSA "or.~ I\ND wc220412i01403 02/06/2006 02/06/2007 I ,,'ves :-ATt. I I(-~~"
<br /> ~ EMfi'LOYF.RS' UABIL~TY TOR.,. uM '..~.
<br /> ; 2~~:~~f~:~~;~:~~~!~~:~~~!.~,~~.c(;UTiVE EL EA.CH A,(:(.IDENT 'I~ 100000
<br />B I c.!.. DI'.;~ASE .. EA t:MF'L~JYt::t: :r; 500000
<br /> i I".~ r:~:' .::;.5,'lt''€ '.;!"'I'J~" -
<br /> ~:::: ~(: .~:.L ::~. ::' \!l'~; Ot<i':: i: '~I.;;~'" EL C11SEASE - POLICY LlM~~' $ 100000
<br />A : O"fHER Liquor Liability 02BP16163330 0' /23/2006 12/31/2006 CSL - $2/000,000
<br /> ; ~otal Limit - $4tOCO,OOO
<br /> ,
<br /> I -----.---.--..-...... - ----. -... -...-.-..-.-..-
<br />oe~CRIPT:ON OF OPERA TIONS/lOCA TIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PRO'liSIONS
<br />Provide~ Evidence of Insurance
<br />
<br />ACOtiO-25 (i001i08).----.--~-------
<br />INSOl5 ('J D:~.~ .):~ AMS
<br />
<br />CANCELLA nON
<br />SHOULD ANV OF THE ABove DESCRlaeO POLICIES BE CANCEU..I:O BEFORE THE
<br />EXPIRATION DATE THEREOF, THE ISSuiNG II'JSURER ~iLL ENOEAVtJR TO MAIL
<br />~ DAYS ~~rrEN NOTICE TO THe CERTIFfCAlE HOLDER. NAMED ~~'L'EFT, 'BUT
<br />FAILURE TO 00 SO SHALL IMPOSE NO OBlIG,'\TION OR L1ABlL~TY OF AN'( KIND UPON THE
<br />INSURER, IT'S AGENTS OR REPRES&NTA'rIVES.
<br />AUTHORIZED REPRESENTATIVE __ _._,_~___..... __
<br />Jeffrey Stanley/AML ~~~~~~~~
<br />(;ACORD COR'PClRATION 1988
<br />
<br />CERT'FICATE HOLDER
<br />
<br />Cit~ of Centerville
<br />188'0 MaiD Street
<br />.Centez:ville, NN 55038
<br />
<br />.,lt~iF' Mr)ttgege SOI:.:tlonS,lnc ($:)0)3:7-0545
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<br />33
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