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2007-11-28 CC Packet
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2007-11-28 CC Packet
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11/21/2007 2:30:06 PM
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11/21/2007 2:29:11 PM
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<br />. .te: 11/07/07 T:La.: 08:35 AM To: 651-429-8629 651-641-898'1 Page: 001-001 <br />. . <br />. . <br />. . <br />. . <br /> ACORD... CERTIFICATE OF LIABILITY INSURANCE I DATE lMlWDI'l'VYYI <br /> 11/7/2007 <br /> PRODUCER (651) 644-0311 FAX (651) 641-8981 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Paulet/Slater, Xnc ONLY AND CONFERS NO RIGHTS UPON THE CER11FICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 2610 University Ave. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> St. Paul HN 55114 INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: SFM <br /> SaHawk of ~nnesota, Xnc. INSURER B: State National <br /> dba: Sagers Bar and Grill INSURER C: <br /> 7098 Centervil1e ad INSURER D: <br /> Centervil1e HN 55038 INSURER E: <br /> <br />COVERAGES <br /> <br />THE POLICIES OF INSURANCE LISTED 8ELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY <br />REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VIA-lICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, <br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. <br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR DD'L TYPE OF INSURANCE POLICY NUMBER PcPA~~:'~&Wf 1'"2\;ICY EXPIRATION LIMITS <br /> DA'IE (MMlDD/YV1 <br /> .!!NERAL LIABILITY EACH OCCURRENCE S <br /> - ~MERCIAL GENERAL UAElILITY ~~~~~~~9E~~~~.f~encel s <br /> - CLAIMS MADE 0 OCCUR MED EXP (Anyone personl S <br /> PERSONAL &ADVINJURY S <br /> GENERAL AGGREGATE S <br /> - <br /> ~'L AGG~En~IMo~ nS PER PRODUCTS. COMP/OP AGG S <br /> POLICY J~CT LOC <br /> !.,.IITOMOBILE LiABILITY COMBINED SJNGlE LIMIT S <br /> (Ea accident) <br /> - ANY AUTO <br /> I.- ALL OWNED AUTOS BODILY INJURY <br /> (Per personl S <br /> I-- SCHEDULED AUTOS <br /> I-- HIRED AUTOS BODILY INJURY S <br /> NON-OWNED AUTOS (Per accident) <br /> I-- <br /> I.- PROPERTY DAMAGE S <br /> (Per accident) <br /> ~RAGE L1ABIUTY AUTO ONLY - EA ACCIDENT S <br /> ANY AUTO OTIiER THAN EA ACC S <br /> AUTO ONLY: AGG S <br /> :5ESSAJMBRELLA LIABILITY EACH OCOJRRENCE S <br /> OCCUR 0 CLAIMS ""ADE AGGREGATE S <br /> S <br /> rl ~DUCTIBLE S <br /> RETENTION S S <br />A WORKERS COMPENSATION AND lr'b'Ri L fr.1Ns I IU~~ <br /> EMPLOYERS'LIABILITY 100,000 <br /> ANY PROPRIETORIPARTNER/EXECUTIVE E L. EACH ACCIDENT S <br /> OFFICERIMEMBER EXCLUDED? 027427201 5/26/2007 5/26/2008 E.L. DISEASE. EA EMPLOYEE S 100,000 <br /> lIyes, destrib. under 500,000 <br /> SPECIAL PROVISIONS below EL. DISEASE. POLICY LIMIT S <br />B OTHER Liquor Liability RCAOO312306 01/01/2008 l2/3l/2008 02,000,000 Av;revate <br /> $1,000,000 Occurr <br />DESCRlPnoN OF ClPERATIONSIlOCATlDNSNEHICLESlEXCLUSION8 ADDED BY ENOOReEMENfISPECIAL PI\OVlSI0N8 <br /> <br />CERnFICATE HOLDER <br /> <br />CANCElLA nON <br /> <br />(651)429-8629 SHOULD ANY OF 'TllE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE T1iE <br />City of Centerville EXPIRATION DATE THEREOF, THE ISSUING INSURER ,^,-L ~ MAIL <br />attn; Theresa ~ DAYS WRITT~ NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ~ <br />1880 Main Street <br />Centervil1e, MN 55038 <br /> AUTIiORlZED REPRESENTATIVE ~-.t- <br /> Jeffrey Stanley/AML ~ \. <br /> <br />ACORD 25 (2001/08) <br />INS025 (0108).06 AMS <br /> <br />VMPM.rtgElge 8oluli.n., Inc. (800)327.0545 <br /> <br />C> ACORD CORPORA TION 1988 <br />P"llOlo12 <br />
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