2015-01-14 CC Agenda Packet - Laserfiche WebLink

Home Browse Search

ACC>RCERTIFICATE OF LIABILITY INSURANCE 7/2/2014 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(ies) 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 NAME: y NanC Rasmussen Christensen Group Insurance PHONE (952)653-1000 FAXJWGJW�F�- A/C (952)653-1101 11100 Bren Road West E-MAIL .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 INSURERE: 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. INSRTYPE OF INSURANCE D L UBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100 000 PREMISE Ea occurrence $ r A CLAIMS-MADE X OCCUR L19446710266 /30/2014 6/30/2015 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 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 PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVEE L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED ❑ N/A (Mandatory In NH) E.L DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below I E.L DISEASE-POLICY LIMIT $ A Liquor Liability L19446710266 /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) 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 Centerville ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Teresa Bender 1880 Main Street AUTHORIZED REPRESENTATIVE Centerville, MN 55038 John Hendrickson/NRS ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSn25/9ninn51 M Tha Or npi1 nnma anti Inn^Ira ranie4arari morke of Armon 52