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<br />ACOBJ:t CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDD/YYYY) <br />10/25/2005 <br />PRODUCER (651)644-0311 FAX (651)641-8981 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Paul et/Slater, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />2610 University Ave., #200 ALTER THE COVERAGE AFt=ORDED BY THE POLICIES BELOW. <br />St. Paul, MN 55114 <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> ,,' <br />INSURED Wi seguys , Pi zza Inc INSURER A: Hartford Insurance <br />7095 20th Avenue S INSURER B: Safeco Insurance <br />Centerville, MN 55038-0000 INSURER c: <br /> INSURE;R D: - - <br /> INSURER E: <br /> <br />r.OVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBjECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />I~i': ~~~~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> - DAMAGE TO RENTED <br /> COMMERCIAL GENERAL LIABILITY $ <br /> I CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $ <br /> PERSONAL & ADV INJURY $ <br /> - <br /> GENERAL AGGREGATE $ <br /> - <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS.COM~OPAGG $ <br /> ~ ,nPRO. n <br /> POLICY JECT LOC <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> - (Ea accident) $ <br /> ANY AUTO <br /> - ,- , ' -'~~ IV'ED <br /> ALL OWNED AUTOS REOE; BODILY INJURY <br /> - $ <br /> SCHEDULED AUTOS (Per person) <br />- -- = ------------------- OCI~--' ~LOOS-~- ----~--~_._- <br /> HIRED AUTOS BODILY INJURY <br /> - $ <br /> NON-0WNED AUTOS (Per accident) <br /> - " <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $ <br /> ==i ANY AUTO OTHER THAN EAACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ <br /> =:l OCCUR D CLAIMS MADE AGGREGATE $'" ", <br /> $ <br /> ~' ~EDU:TIBLE $ : <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND 41WECPM6255 11/24/2005 11/24/2006 11,(~,)I:~I,~~l IOJ~' <br /> EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 100000 <br />A ANY PROPRIETORlPARTNERlEXECUTIVE <br />OFFICER/MEMBER EXCLUDED? E.L. DISEASE. EA EMPLOYEE $ 100000 <br /> If yes, describe under E.L. DISEASE. POLICY LIMIT $ 500000 <br /> SPECIAL PROVISIONS below <br /> OlHER Liability RENEWAL OF 02BP240321 01/01/2006 01/01/2007 $1,000,000 Ea Common Cause <br />B Llquor $2,000,000 Aggregate <br />p~ESCRlPTION OF OPERATIONS' LOCATIONS 'VEHICLES' EXCLUSIONS ADDED BY ENDORSEMENT' SPECIAL PROVISIONS <br />rovides Evidence of Insurance <br /> <br /> <br /> <br />City of Centerville <br />1880 Main Street <br />Centerville, MN 55038 <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY <br />OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE ~~ ~ <br />Jeffre '-tL:. <br /> <br />ACORD 25 (2001/08) FAX: (651)429-8629 <br /> <br />@ACORDCORPORA::;;:;~ <br />