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Mercer Consumer®a service of <br /> Mercer Health&Benefits Administration LLC <br /> y�ior �Wu� >,� ���� R PO ox 14575 <br /> Des Io���rdV« Q ��� [A 50306 <br /> �Umuue i1W � nwi� ���i oli9�S, <br /> Certificiate of llln ll°arli s I1:2oi m <br /> ...... m .............................__..__. . ..., _ ......... _ _......................... _.... <br /> Are you cuirreinll Oiive inaernbeir, aryour, it nisi. "fl in' Yes N <br /> .l'.Iil liie...Certificate r x ui„meat foam life for t,irDilfe loom 'l..fini d'ivliduala,clu,�bs,and clh II ....... <br /> ........... a„, alters. <br /> Name of Organization 1 Association: Anoka County Radio Club <br /> Name 1 Chapter Name. Tim Neu <br /> Policy Number r Client Number: RGL-724053310 <br /> Name, i Certificate: <br /> Anoka County Radio Club <br /> PO Box 982 <br /> Anoka,MN 55303 <br /> Telephone : 651-366-0021 Email Address., tim,neu@gmail.com <br /> How would you likeCertificate Insurance <br /> rFaxt I El is Holder: <br /> Email ® tirn.neu@gmaii.com 11 Certificate : <br /> Mail : El Certificate : <br /> 1. Name of event: Halloween special event station <br /> . Location of the event(Name and Address): <br /> Laurie Lamotte Park <br /> 6970 Lamotte Dr <br /> Centerville,MN 55038 <br /> 3. Date of the u : 10/31/17 <br /> . Name of entity(including mailing address) requesting proof of liability coverage: <br /> City of Centerville <br /> 1880 Main Street <br /> Centerville,MN <br /> 55038 <br />