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Aco d CERTIFICATE OF LIABILITY INSURANCE DAMMA :It/PM <br /> 4,,,.....-. 12/07 <br /> PRODUCER - THIS CERTIFICATION IS ISSUED AS A MATTE OF INFORMATION <br /> Wilts of Minds, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 233 S. Wacker Drive, Suite 2000 HOLDER. TIPS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> Chicago IL 60606 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Phone: (800) 316.6705 Fax: (312) 234-0636 INSURERS AFFORDING COVERAGE NNC M <br /> 11411URED INSURER* ACE Amefan Insurance Company 22867 <br /> Centerville Lions Club INSURER B. <br /> Minnesota <br /> INSURER C: <br /> INSURER D. <br /> INSURER E: <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOWHAVE 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 SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES. AGGREGATE LIMITS SHOVM MAY HAVE BEEN REDUCED BY PAID CLAIMS. MY NN <br /> FORAM UR Pa TYPE OF RISNCE POLICY NA DER PATE �� DATi I1R 1ppfyyYY) LIMITS <br /> GENERAL LIABILITY 09/01/2009 09101/2010 EACH OCCURRENCE $ 1,000,000 <br /> A X COMMERCIAL GENERAL LIAHILRY H00024934044 <br /> DAMN* WNW m 1 1.000,000 <br /> 1 PREMISES (Ea auoence) <br /> CLAWS MADE El OCCUR MEDEAP (Any cos psrtcn) $ 1,000 <br /> _ PERSONAL a ADV*UJRY $ 1.000,000 <br /> GENERAL AGGREGATE $ 10,000.000 <br /> GGEEN� f 7ECT T AGGREGATE L&117 APPLIES PER PRODUCTS • 00/4410P AGO 1 2,000,000 <br /> -- X1 POLICY I -- 1 LOC AGG PER NAMD INS 1 2,000,000 <br /> AUTOMOBILE LIABILITY HOOG24934044 09Al2009 09m1f2010 COMBINED SNGLELIMR $ INCLUDED <br /> A _ANY AUTO (Ea wart) <br /> ALL OWNED AUTOS BODILY INJURY <br /> SCNEDULEDALTOS en ) S IN ABOVE <br /> X HIREDAUTOS BODILY INJURY <br /> $ <br /> X NON -0VACED AUTOS Per esodent) <br /> PROPERTY OLIAAGE 1 <br /> (Parllcadarli) <br /> GARAGE LIABUTT ALTO ONLY -EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EP.ACC $ <br /> AUTO ONLY AGO 1 <br /> EXCESS / WBRmLLA LIABILITY EACH OCCURRENCE 4 <br /> 7 1 OCCUR I 1 CLAMS MADE AGGREGATE _ _ 4 <br /> 1 <br /> DEDUCTIBLE F <br /> RETENTION $ 1 <br /> WORKERS COMPENSATOR At (TORY LWU- IOER <br /> EMPLOY/RIFUSW? <br /> ANY FROPRIETORIPARTIEH .EJ>IECLMVED EL. EACH AOCIOENT 1 <br /> OOFFFICERIM�EM EXCLUDED? LJ EL DISEASE- EAEMPLOYEE 1 <br /> RNs, dnaiM IIdar � <br /> APEMAN PROVISIfNC bsav EL DISEASE - POLICY LIMIT 1 <br /> ORER <br /> DESORPTION OF OPERATIONS LOCATIONS / V@SCLES /EXCLUSIONS ADDED SY 53001gEMBRr SPECIAL PROVISIONS <br /> • <br /> Provisions of the policy apply to the named insureds participation in the following activity during the policy period shown above: 2010 Centerville Lions Ice Fishing Contest <br /> Anoka Courtly Sheriff is Inoluded as en Additional Insured(s). but only with respect to General Liability arising out of the issuance of permit(s) to the Insured shown above and not out of the sole <br /> negl nce of said ad insu DO red <br /> PROVISIONS OF THE POLICY NOT APPLY TO THE SALE OR SERVING OF ALCOHOLIC BEVERAGES <br /> CERTIFICATE HOLDER CANCELLATION <br /> Anoka County Sheriff MOULD AIM OF SHE ABOVE DESCRIBED POLICE{ SE CANCE4LEDBEFORETIE EXHRATEN <br /> 1350 Bunker Lake Blvd 55 304 <br /> Andover Minnesota 55 DATE T)R3EOP T!E Sµl(NG SAU TER WILL ENDEAVOR TO KM 30 DAYS wiener <br /> NOTICE TO THE CeRTFICATE FOLDER MIMED TO THE LEFT, BUT FAILU E 1000 SO SHALL <br /> IMPOSE NO OSLOATION OR LUIBILRV OF ANY I0ID UPON THE IMAM ITS ARDOR OR <br /> REPRESElTA1Na <br /> AUfOOZED REPRESENTATIVE <br /> John E. Adams <br /> ACORD 25 (2009/01) ®191192009 ACORD CORPORATION. All rights reserved. <br /> 32 <br />