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<br />ACORD CERTIFiCATE OF LIABILITY INSURANCE <br />m <br /> <br />CATE (MMJDDIYY) <br />06/12/2002 <br /> <br />PRODUCER (952)893-9218 <br />CORPORATE 4 INS AGENCY, <br />7220 METRO BOULEVARD <br />EDINA, MN 55439-2133 <br /> <br />FAX (952)893-9402 <br />INC. <br /> <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE; POLICIES BELOW. <br /> <br />INSURERS AFFORDING COVERAGE <br /> <br />General Star Indemnity <br /> <br />INSURED <br /> <br />INSURER A: <br /> <br />Centerville Lions Club <br />7389 Old Mill Road <br />Centerville, MN 55038 <br /> <br />INSURER 8: <br />INSURER c: <br />INSURER D: <br />INSURER E: <br /> <br />COVE GES <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE Pouey PERIOD INDICA TED. N07W1THSTANDING <br />ANY REQUIRE.MENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENTW/TH RESPECT TO WHICHTHJS CERTlFJCATE MAY BE ISSUED OR <br />MAY PERTAIN, THE iNSURANCE AFFORDED BY THE POLICiES OESCRIBED HERElN ]S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONomONS OF SUCH <br />POLICIES. AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR TYPE OF INSURANCE POUCY NUMBER DATE (MMlDotWf DAre IMMJDDIVY} LIMITS <br /> ~NERAL L.IABIUlY EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) , <br /> l CLAIMS MADE 0 OCCUR MED EXP (Any ane person) , <br /> - PERSONAL & ADV INJuRY , <br /> - GENERAL AGGREGATE , <br /> ~'lAG~nE LIMIT APnS PER: PRODUCTS - COMPfOP AGG , <br /> POLICY j~T LOC <br /> ~OMOBILE LIABIliTY COMBINED SINGLE LIMIT , <br /> ANY AUTO (Eaaecident) <br /> - <br /> - All OWNED AUTOS 80DCL Y INJURY <br /> (Per person) , <br /> - SCHEDULED AUTOS <br /> - HIRED AUTOS THIS INSURANCE IS ISS ED PIJRSUII.., T TO BODILY INJURY <br /> !; LINES INSU}i {Per accident) $ <br /> - NON-OWNED AUTOS It';:: MINNESOTA SURPlU I't.;C'= <br /> ACT. THE INSURER IS ~~ ELIGIBLE SU ~ljUS PROPERTY DAMAGE <br /> LINES INSURER B~T I NOT OTHER ISE (Per accident) , <br /> -,;-; <br /> RRAGE LiABiLiTY 'or 1m: 01"" Jr, .AiMS AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO CASE OF INSOLVENCY, P '" YMENT OF C EAACC <br /> IS NOT GUARANTEED. OTHER THAN , <br /> AUTO ONLY: AGG $ <br /> EXCESS LIABIUlY SURPLUS LINES TAX EACH OCCURRENCE , <br /> LrOCCUR 0 CtAlMS MADE AGGREGATE , <br /> $ <br /> R ~EDUCT1BLE , <br /> RETENTION , , <br /> WORKERS COMPENSATION AND I To"R,;' li'Mi'fS I 1u E,\'- <br /> EMPLOYERS' LIABILITY E.L. EACH ACCIDENT <br /> , <br /> E.L. DISEASE - EA EMPLOYEE , <br /> E.L. DISEASE - POLICY LIMIT , <br /> OTHER lIMA574028 06/30/2002 06/30/2003 $1,000,000 each common cause <br /> li quor Liability " <br />A ..,..' $1,000,000 aggregate <br />DESCRIPTION OF OPERATlONSlLOCATlONSNEHICLESfEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES B~ CANCELLED BEFORE THE I <br /> E(pIRATION DATE THEREOF, Tl-lE ISSUING COMPANY WlL\.ENDEAVOR TO MAIL <br /> .....10-- DAYS WRmEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br /> City of Centervil1e SUT FAILURE TO MAIL SUCH NOTICE SHALl. IMPOSE NO OBLIGATION OR LIABILITY I <br /> 1880 Main St. OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. <br /> Centervil1e, MN 55038 I ~UTHORJZED REPRESENTATIVE ~ cJ2.~N <br /> Jane Johnson/MB <br /> I <.-::s in"1) c i.O' <br /> <br />I <br />l _ I <br />