2015-01-14 CC Agenda Packet - Laserfiche WebLink

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A O RE® CERTIFICATE OF LIABILITY INSURANCE D�2�2oi4) THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT ME: y NanC Rasmussen NA Christensen Group Insurance PHONE (952)653-1000 FAXC. (952)653-1101 11100 Bren Road West E-MAILADDRESS.nrasmussen@christensengroup.com INSURER(S) AFFORDING COVERAGE NAIC# Minnetonka MN 55343 INSURERA:Great American E&S Ins Co INSURED INSURER B LIONS CLUBS OF MINNESOTA, INSURER C: c/o The Christensen Group INSURER D: 11100 Bren Road West INSURER E: Minnetonka MN 55343 INSURER F: COVERAGES CERTIFICATE NUMBER:6/30/2014 Liquor REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE A L BR POLICY NUMBER MM/DD1 EFF IPOLI D EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE-To RELATE ZOO 000 PREMISES Ea occurrence $ � A 7 CLAIMS-MADE a OCCUR PL19446710266 6/30/2014 6/30/2015 MED EXP(Any one person) $ 5,OOO X Gen Agg Limit-per member PERSONAL&ADV INJURY $ 1,OOO,OOO GENERAL AGGREGATE $ 2,OOO,OOO GEML AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000f000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident_ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS $ NON-OWNED PerOaccidentDAMAGE HIRED AUTOS AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N JQRY LIMITS FIR ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED ❑ N I A (Mandatory In NH) E.L DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $ A Liquor Liability PL19446710266 /30/2014 6/30/2015 EachOccurrence- $1,000,000 Aggregate. $2,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Member Club: Centerville Lions Club Address: 7026 Centerville Road, Centerville, MN 55038. Certificate Holder is included as Additional Insured as their interest may appear in the operations of the club named above. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Lino Lakes ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Julie Bartell 600 Town Center Parkway AUTHORIZED REPRESENTATIVE Lino Lakes, MN 55014 John Hendrickson/NRM ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSn25/9n1nn9)M Tho arnpn namo onrl Innn oro roniefororl mor4c of arnan 48