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Order Receipt Page 1 of 1 <br /> BAWD A <br /> WATER SKI <br /> Your order was processed successfully. $100.00 was charged to the credit <br /> card ending in 5138 belonging to Dawn Clyne.Your order number is <br /> C6DB84F7. This page can act as your receipt, you may want to print it for <br /> your records. A copy has also been emailed to you. <br /> CLUB INFORMATION <br /> Club Name: Bald Eagle Water Ski Show Team Inc <br /> CONTACT INFORMATION <br /> Primary Contact Mark Spitzmueller (Mem. #: 96496) <br /> Information: 6521 White Oak Rd <br /> Lino Lakes, MN 55038 <br /> s°itzmr0Yahoo.00tn <br /> (651) 653 -8871 (h) <br /> (763) 786 -2205 (w) <br /> (651) 983 -0161 (m) <br /> ADDITIONAL INSURED INFORMATION <br /> Additional Insured Name: City of Centerville <br /> *1 Address: 1880 Main St <br /> Centerville, Minnesota 55038 <br /> Phone Numbers: (651) 429 -3232 (w) <br /> Certificate for: Year Round Club Activity <br /> Uability Agreement Held: YES <br /> Additional Insured Status: Required (Role is <br /> Additional Insured Name: Board of Water Commisioners of the City of <br /> *2 St. Paul - *same verbage as 2011* <br /> Address: 1900 Rice Street <br /> St. Paul, Minnesota 55113 <br /> Phone Numbers: (000) 000 -0000 (w) <br /> Certificate for: Year Round Club Activity <br /> Uability NO <br /> Agreement Held: <br /> Additional Required (Role is Property Owner) <br /> Insured status: <br /> ORDER SUMMARY <br /> - Additional Insured Certificate for City of Centerville $50.00 <br /> - Additional Insured Certificate for Board of Water Commisionens of the City $50.00 <br /> of St. Paul - *same verbage as 2011* <br /> TOTAL: $100.00 <br /> Reference Number: W <br /> Campaign: <br /> USA Water Ski Home <br /> http: / /www.usawaterski.org/ members/ clubs/renew /process.asp ?OrderIID= {C6DBB4F7 -57... 5/712012 <br />