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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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<br />1~/31/2e07 16:15 <br /> <br />6514290843 <br /> <br />BEULKE INS MTG <br /> <br />PAGE 02/El2 <br /> <br />I Certificate of Insurance <br /> <br />~.... Beulke Agency, Inc IG2Z40 <br />-&782 WHhlnglon Ave <br />WhIle B_r...... MN 55111 <br /> <br />The InterAgerql8laddun, NIckeIa & SmIth, lno. <br />Box 41248 <br />PttmNh, MN 55447 <br /> <br />_I Trio Inn, MoLIdaIn 1!nte1'pl1le1l. tnc. DBA: <br />6510 Cent8nIIe Road <br />th) 1.8k8s, MN S5038 <br />Coverage <br /> <br />This is 10 certifY that the policies af Insurance listed below have been ls9ued fa the Insured n.mad above for the policy <br />period 1ndic8Ied. not withatandlng any requirement, term or conclllon of any contrac\. or other document with respect to <br />which this certificate may be Issued or may pertain, the Insurance afforded by the policies described herein Is SUbject to <br />all the terms, excluSions and candlUons 01 such polcies. Limits shown may have beerh reduced by paid claims. <br /> <br />1013112007 <br /> <br />I <br /> <br />lHlS CERTIFICATI IS ISSU&D AS It. MATTER Of <br />INFOAMA11ON ONLY. AND CONFERS NO RIGHTS UPON <br />THE CER"I'FICATE "IOLDER. THIS CERTIFICATE DOES <br />NOT AMINO. EXTeND OR ALTER THE COVERAGE <br />AFFORDED BY THE POUCIIS BELOW. <br /> <br />Company Providing Coverage: <br /> <br />Capitol Specialty Insurance <br /> <br />~ of InlUf'lnc8 ~ Number Policy Eff8cIIve PaIIcy ExptaIon L1mlta <br /> o. OaIe <br />General LiablIly General Aggregate <br /> Products. iCOmpOp Agg <br />Cornm1 Gen. LIab. Personal '-AIJy Injury <br /> eaCh Occurrence <br /> Fh ~Ia (Any One fire) <br /> Med Exp flint One Per'!lon) <br />liquor LiablTIty CS00330517 12/3112007 1213112008 Aggntg8Ie I.fmlt S50D/Ooo <br /> ea. CommCln Cause Lmil '500.000 <br />PROPERTY UmHa: comurance: Form: Deductible: <br />S"ding: <br />Busnss Personal Property. ----m:CElVEO-. .- <br />Business Inc:ame: <br />LOCATION( OF RISK 1082 CemerviIe Road, CtnltNlle. MN 55038 I1UY U I LUUI <br />DESCRIPTION OF RISK Tavem. uquor Llablly CENTERVILL.E, MN <br />[Certificate Holder Additional Insureds Cancellation I <br /> <br />City of centerville <br />1880 Main srreet <br />CenlervilJe, MN 55038 <br /> <br />ShOUld anr Df lite dncrlb8l1 pollciee be canc:8l8d befol8lhe Illphtlan ... <br />Iher8of. the Issuing 1lDIIlp.., will endeavor fa II1II1 30 d8)s wdIlm naIfat <br />01 ClM8II8tIoft 10 .,. ., named to _lei. ht ro mill <br />Mh Idlcl ahalllllJlOl8 uon or lIabllaV the <br />campany. Il8 egea\I or <br />AuIhOdzed RepfelenlAlIve Jim Holm btl......I.com <br /> <br />
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