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<br />ACORQ. ,CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIOD1YYYY)
<br />07/05/2005
<br />PRODUCER (952)893-9218 FAX (952)893-9402 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />CORPORATE 4 INS AGENCY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />7220 METRO BOULEVARD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
<br />EDINA, MN 55439-2133
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br />INSURED Centerville Lions C1UD INSURER A:. Lexington Insurance Co.
<br />7155 Brian Drive iNSURER B:
<br />Centervi 11 e, MN 55038 INSURER c.
<br /> INSURER 0"
<br /> INSURER E:
<br />
<br />COVERAI>F"
<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 />INSR DO' TYPE OF INSURANCE POUCY NUMBER POLlCY EFFECTIVE PRi'.fJ, EXPIRATION LIMITS
<br /> GENERAL UABIUTY EACH OCCURRENCE ,
<br /> f-- DAMAGE TO RENTED
<br /> COMMERCIAL GENERAL lIABILITY ,
<br /> I CLAIMS MADE D OCCUR R" CErVI MEO EXP (Anyone person) ,
<br /> .",.{ D PERSONAL & ADV INJURY ,
<br /> f- 4'_","::,.
<br /> GENERAL AGGREGATE ,
<br /> f-- I .tL U 6 200
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: .J PRODUCTS - COMP/QP AGG ,
<br /> h ,nPRO. n
<br /> POLICY JEer lOC
<br /> AUTOMOBILE UABILJTY COMBINED SINGLE LIMIT
<br /> - (Eaaccident) ,
<br /> ANY AUTO
<br /> -
<br /> ALL OWNED AUTOS BODilY INJURY
<br /> - ,
<br /> SCHEDULED AUTOS (Per person)
<br /> f-- NT TO
<br /> HIRED AUTOS THIS INSURANCE"I~,I~ UED PURSUt BODILY INJURY
<br /> '-- i~:: ;.'t,T') i~'!SlJ AMCE (Per accident) ,
<br /> NON-oWNED AUTOS Ti<~ MINNE '- ;:')'~i\___:-,.\
<br /> - ;-\C-I-. THE 1i'~..::~;Hr,~F~ j;~; /1,: , ;;.:UOii.:.U: ~;U ;PLUS
<br /> - LiNES INSUREH 8L:, ; :; t'lOT OTHE ~WI~~ PROPERTY DAMAGE. ,
<br /> (Peraccidenl)
<br /> GARAGE LIABIUTY - D' '''~ ~, LAIMS AUTO QNL Y - EA ACCIDENT ,
<br /> y'ANY AUTO CASE OF INSOLVENCY, AYMENT OF
<br /> IS NOT GUARANTEED. OTHER THAN EA Ace ,
<br /> AUTO ONL V: AGG $
<br /> ~ESSlUMBRELLA UABIUTY SURPLUS LINES TAX EACH OCCURRENCE ,
<br /> OCCUR D CLAIMS MADE AGGREGATE ,
<br /> ,
<br /> R DEDUCTIBLE ,
<br /> RETENTION $ ,
<br /> WORKERS COMPENSATION AND I T'X~.;;mg< I 10J6'-
<br /> EMPLOYERS' UABiLITY E.L EACH ACCIDENT ,
<br /> ANY PROPRIETORlPARTNERlEXECUTIVE
<br /> OFTICERlMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE S
<br /> If yes, des::.riba under E.L DISEASE - POLICY LIMIT ,
<br /> SPECIAL PROVISIONS below
<br /> O;rHER Liabil ity 234075102 06/30/2005 06/30/2006 See Below
<br />A Llquor
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT J SPECIAL PROVISIONS
<br />Limits: $10,000 PO each occurrence/$300,OOO BI each person and each occurrence/$300 , 000 loss of
<br />support each person and each occurrence/$600,OOO aggregate limit per club.
<br />
<br />CERTIFICATE HnLDFR CANCELLATln'"
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORe THE
<br /> EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
<br />City of Centerville ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
<br />ATTN: Teresa Bender BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LlABILlTY
<br />1880 Main Street OF ANY IOND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
<br />Centervi 11 e, MN 55038 AUTHORIZED REPRESENTATIVE cf) '?X:',.-;!~?F
<br /> Dan Li ndsav /MARYB
<br />
<br />ACORD 25 (2001/08)
<br />
<br />@ACORDCORPORATION 1988
<br />
<br />.5~c
<br />
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