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<br />08/21/2008 22:48 FAX 8528470183 <br /> <br />UMPM,IHC. <br /> <br />III 002/002 <br /> <br />ACORD... CERTIFICAT ..... OF LIABILITY INSURA~ ,.,E I gATE (MlWglVV) <br />'2130105 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />UMPM. Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOl-peR. THIS CERnFICATE OOES NOT AMEND, EXTEND OR <br />9975 valley View Rd. ALTEFI THE COVERAGE AFFORDED BY THE; POLICIES BELOW. <br />Suite D <br />Eden pll1lrle, MN 55343 INSURERS AFFORDING COVERAGE <br />S52-947-0161 .-- -....-.- --' . <br />INSURltl INSUR5FI A STATE NATlONAL INSUFlANCE COMPANY <br />TFlIO INN INSuRER B. <br />MOUNTAIN ENTERPRISES,INC. DBA! -- ...... <br />7082 CE::lIITeRVILLE ROAD INSURER C: <br /> .. .....--... .-. --... <br />CENTERVllLE, MN 55038 INSlJR5R D; - <br /> --.- --"-. <br /> INSlIR5R E;: <br /> <br />COVERAGES <br /> <br /> THE rOLlCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERI OJ INDICATED. NOlWlTHSTANDING <br /> AN" f<EQUII<EMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WliH r.tesPECT TO WHICH THIS CEIITIFICATE MAY BE ISSUED OR <br /> ~'Av PERTAIN. THE INSURANCE AFFORDED BV THE POI.ICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES AGGREGATE LIMITS S~OWN MAY HAVE; BE;EN REOUCEO BY PAID CLAIMS. <br />INS':! .. . -----. ---...- ..-. . 1"'-__ ~~'i EFFECTIIIE ~Itf: I~~~~~~ -- .--- --. ---.. . <br />TVP! OF INSURANC!;: POLICY NUMBER , LIMITS <br />LTR I I <br /> i Gll:NI:AAL UA81UTV EACH OCCURRENCE S <br /> ~ . - .-.. -. --.... .. <br /> I COMMERCLo\L GENEAAL LIABILI1'1 FIRE DAMAGE (MY ons rors) S <br /> I .. CLAIMS MACE T- OCCUR MED EXP (^ny Oil. p.,_] S <br /> ------. . <br /> f'EASQNAL & ACV IN.NRV 5 <br /> -- I.... ___._..... <br /> GENERAL AGGREGATE . 5 <br /> -=~- <br /> , ~'L AGG~E~ LIMIT A"''''nER' FRODUCTS . COMFiOF AI3G S <br /> I , POLICY ~l'&1r L.OC ..._- ........ ...- <br /> ~TOr.coBILl L1ABILrTl' , <br /> COM8111/6"O SIII/GLE LIMIT S <br /> ANY AuTO (Ea 9cci~enl) <br /> -. <br /> ALL OWNED AUTOS 80DIL Y INJURY <br /> - S <br /> SCHEDU~E;O AUTOS ' (Pel pefl;On) <br /> .-.-- --.. <br /> !.._.1 HIRED AUTOS OODIL'f INJURY $ <br /> NON.OWNED AUTOS IP9' .cclOanO <br /> -. -.-.- <br /> -- ---- , PRO~Efll'f DAMAGE 5 <br /> , (F., ace O.nll <br /> I <br /> CARAGl LIA81LITY i ~ A~~Q O~L_~.:_~_ACCI~S.. <br /> ... .. <br /> ANV "UTO o rHEA TH"N EA ACC.. .i-~.._.- <br /> AUTe ONLY AGO $ <br /> IiltC lSS LIA 81LITY , <br /> I ~'" o,,~'"'"'" s <br />r~~ OCCUR L CLAIMS MAllE 1 <br /> AClClREClATE $ <br /> u. <br /> s <br /> u_ __ <br /> '- .1 DEDUCTIBLE I S <br /> RE'lENTION S S <br /> WORlCER$ COMPPlSA11DN AND I T';;~P~J~ i IOJ~. <br /> I!MPLOVER$' LIABILITY -..- <br /> EL EACH ACCIDENT $ <br />I E L DISEASE. EA EMPLOYEE S <br /> .0.0 <br /> E.L. D~EASe: . POLICY LllAlT $ <br />A I OTHER LIQUOR LIABILITY UM 0004144 12-31~5 12-31-06 S300 , 000/300,000 <br /> I I <br />DESCRIPTION 01' OPERATlONS/LOCATlONSlVEHICLESllXCLUllIONll ADDED !lV ENDOA8bll;N'T1VECIAL PROVISIONS <br />TAVERN <br />CERTIFICATE HOLDER I I AtlDIT1QNAL INSURED; INSURm Ll!.TTI!A: CANCELLAnON <br />CITY OF CENTERVILLE SHOULD ANV 0' TIll! A!lOVE DE&CIlI8EC PQUCllS BE CANCElLlZl BEFORE THI! 1!XPuu."ON <br />1880 MAIN STREET DATI! TMI!IlEOI'. TME ISSUINQ INSURER WILL ENDEAVOR TO MAIL ~ DAVe WR~N <br />CENTERVILLE, MN 55038 '0"" 10 TIE '......n ~M1O "" "". IUT FA"'.. 10.... '"AU. <br />ATTN: LIQUOR LICENSE DEPT. IMPOS2 NO oaUGATION OFlI,Idj rTl' Of Y K_ ruN T7 INSURER, IT'S AQ!NT5 01'1 <br /> REPRE8ENTATI\'a. _ () <br /> AUlltORlZED REPRESEN'TATIn ~- r..(1~ r- <br /> ~ <br />ACORD 25-S (7197) @ AcbRD CORPORATION 1988 <br /> <br />$Jj <br />