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<br />_.llt~O/OO _ MON 15..: 48 FAX 651 489 5403 <br /> <br />QUALITY INSURANCE <br /> <br />~OOl <br /> <br />:\:: ACORD <br />:_;.; TIll <br />:":': ',,:.:.~,:.:.:-:.!,.,:.:.:.:,: ,:,;.;,:.:.,:.: :,:~.;.:,:.~:.;.:.:<,: <br /> <br /> <br />DATE !JIIMlOOIYYI <br /> <br />1648 Rice Street <br />St. Paul <br />651.489.1347 <br />INSURlO <br /> <br />12/03/1999 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONL V AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND. exTEND OR <br />Al.TER THE COVERAGE AFFORDED BY THE POUCIES BELOW, <br />COMPANIES AFFORDING COVERAGE <br /> <br />PRODUCeR <br />Quality Insurance Service, Inc. <br /> <br />MN <br /> <br />55117 <br /> <br />I <br />f~!ANY <br /> <br />Lex1ngton <br /> <br />I KELLY'S KORNER INC, <br />7098 Centervil1e Road <br />Bill Bi sek " Cor~.ANY <br />b Centerv 11 e HN 55038 , D <br /> <br />I <br />THIS is TO Cl:RTIFY THAT THE POLICIES OF INSURANce LISTED BEI.OW HAVE BEEN ISSUED iO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />I INDICATED, NOTWITHSTANDING ANY REQUIREMEr~T, URM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT V~ITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY 8E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE ='OUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. <br />I eXCLUSIONS AND CONDITIONS OF SUCH POLICIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY F'A1D CLAIMS <br /> <br />, i I ,', POLICY EXP'"ATION , <br />I co ; TYPE OF INSURA'~CE powey !\IUMB!II I POLICY Il'l'ecTIVE '"" <br />l n I DATI {MMIDONY) i DAn (MAiI/ODIY", I <br /> <br />! I GENERAL AGGREGATE <br /> <br />l_~:MBANY <br /> <br />! COMPANY <br />, C <br /> <br />UMITS <br /> <br />~IiRAL UAalLrrY <br />I I COMMERCIAL GENeRAL llA6iUYY <br />~ n <br />~ CLAIMS MADE I OCCUR <br />H OW~jER'S '" CONTRACTOR'S FROT <br /> <br />'-, <br />I <br /> <br />PRODUCTS - COM?IJ P IHi(; I i <br /> <br />PERS,DNAl lit AOV INJUl'IV $ <br />I. <br />FlPE DAMAGE (An~ .r,,, f roj I t <br /> <br />E~CH OCCURRENCE <br /> <br />~OMOIILE L1A9U.rrv <br />I i ANY "'UTa <br />r-: <br />HALL OIVIIlED AUTOS <br />H SCHEDULED Al Tes <br />~ HIRED AUTOS <br />H NON.cWrJED AUTOS <br /> <br />H <br />I I <br /> <br />MED EXP (Anyone o",sonl <br /> <br />COMBINED SINGLE U~'IT II <br /> <br />! I <br />'I EODll Y ,NJURY I' . <br />(Per puroon) <br /> <br />I BODilY INJURY I , <br />I (Per ~':~~~~] <br />I <br />i PRC?EFlTY DAMAGE <br />I <br /> <br /> <br />AU70 ONt Y . eA ACCIDENT <br />~11!f\_TH"'N AUTO ONLY: <br />I EACH ACCiDENT ! ~ <br /> <br />~AGE UABlllTY <br />, i ANY AUTO <br />1---' <br />H <br />, , <br /> <br />EXCESS UA.BILITV <br />JMBRElLA rORM <br /> <br />, EACH OCCURR:NC~ <br /> <br />,- <br /> <br />; OTHeR T>1I\N UiVlaRELLA FORM <br /> <br />I WORKellS COMPENSATION AND I <br />1 IiMPLOYERS' UAIlIUTY <br /> <br />i THS PRO~RIETORI !lINCl <br />i PARTNERslexeCUTlVE ~ <br />OFFICER~ ARE: I! ~XCl <br />OTH ER <br /> <br />i E~ EACH ACCIDEN> <br />EL DISEAse - ?OLICY LIMIT ; <br />Sl DISEIl.SE - EA EN,PLOYEE I 3 <br /> <br />i Liquor L1 abi 1 ; ty <br /> <br />5639863 <br /> <br />01/01/2001 <br /> <br />01/01/2001 i $50,000 per person <br />! SlOO.OOO Per occur <br />$300.000 ger~ral a <br /> <br />DESCRIPTION OF OPEFlATIONS/LQCATIONBIVEHlCLESl6PliClAL ITEIIIS <br /> <br />~~~~ _~rI:: .:t:f1.~ll'QJ~f.j~i~:~\f~jj~1f.~m,~~~~~~~rJf:~~G~i~~1~~~J~j~~~~~f~lf~~11~:~:~~Jm~j~i~t~~{j~@~1ii;i;im:~~lj~~j'~~i~gj;~~~ljl~~~~;~~]~.A:"::' :.:.:::. ..': :: :'::~' <br />City 01' Centerv1l'e SHOULD "NY OP THE A.JOVE DE&CRlBEO POUCIES BE CANClliED BEFORE THE <br />IB8D Mai n street EXPlIlATION DATE llliAiOF, THE ISSUlI'lC COMP,lI.NY WILL ENDEAVOR TO MAil <br />.JL DAVS WRITTEN NOTICE TO THI: CSlTII'1CATE HO"DtR NAMED TO THe Len <br />Centervi" e MN 55038 BUT fAIlURE TO MAlL SUCH NOTIC! SHI\l.L IMPOSE NO OBLIGATION OR .IABlll'!'" <br />ANY. ITS AGENTS O~ ~EP~E.$EIIlTAl1VES, <br /> <br /> <br />