2015-01-14 CC Agenda Packet - Laserfiche WebLink

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ACoRo® CERTIFICATE OF LIABILITY INSURANCE ��2i2oi ' THIS CERTIFICATE IS 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 CONT. AME: T Nay nC Rasmussen N Christensen Group Insurance PHONENo_ (952)653-1000 FAX (952)653-1101 ,JC11100 Bren Road West E-MAIL .nrasmussen@christensengroup.com INSURERS AFFORDING COVERAGE NAIC M 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 TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP OMITS TR POLICY NUMBER MWDD MM D GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ 100,000 A I CLAIMS-MADE aOCCUR PL19446710266 6/30/2014 /30/2015 MED EXP(Any one person) $ 5,000 X Gen Agg Limit-per member PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PFrT —1 RO 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 PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peraccident UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNER/EXECUTIVEN/A E L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT 1$ A Liquor Liability L19446710266 6/30/2014 6/30/2015 Each Occurrence $1,000,000 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Centerville Lions Club ACCORDANCE WITH THE POLICY PROVISIONS. 7155 Brain Drive Centerville, MN 55038 AUTHORIZED REPRESENTATIVE John Hendrickson/NR µ ACORD 25(2010/05) C 1988-2010 ACORD CORPORATION. All rights reserved. INSn25 r9nlnnRi M Tho ar nizirt narno and Inn^aro raniatararl marine^f Armon 51