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/02/2008 TUE 9iO4 FAX 763 694 9955 I1tarAgency <br />er-t fieate of Insurance <br />oRcoueerea. Sunrise Park Ins Agcy Inc <br />2063 East County. Road E <br />White Bear Lake, MN 55110 <br />The interAgency/Blackburn, Nickels & Smith, Inc. <br />Box 47248 <br />Plymouth, MN 55447 <br />(Hsue> p: Country Lounge Inc, DBA; Country Lounge <br />3590 Hoffman. Road W <br />Gem Lake, MN.55110 <br />Ctive'age <br />.927115 <br />ZQQL/001 <br />12/3/2008 <br />THIS. CERTIFICATE iS ISSUED AS A MATTER OF <br />INFORMATION ONLY AND CONFERS NO RIQHTS UPON <br />THE CERTIFICATE HOLDER: THIS CERTIFICATE DOES <br />NOT AMEND, EXTEND OR ALTER THE COVERAGE <br />AFFORDED BY THE POLICIES isELOW. <br />Company Providing Coverage:. <br />Badger Mutual Ins Co <br />This is to. certify that the policies of insurance listed below have been issued to the insured named above forth policy <br />period indicated, not. withstanding any requirement, term or condition of any contract or other d❑.cument with respect to <br />which this: certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to ail <br />the terms, exclusions and conditions of. such policies.. Limits shown may. have been reduced.b.ypaid claims. <br />Type ofl.nsurance <br />General. Liability <br />Policy AfUmber <br />Policy Effective. <br />Date <br />Policy: Expiration <br />Dale <br />Limits <br />C❑ m rri'l Gen. Liab. 00462-00436 12/3.1 /2008. 12/31/2009 <br />Liquor Liability- 00462-00436 12/31 /2008 12/31/2009 <br />PROPERTY <br />Building: <br />Business Personal Property• <br />Business incorrie: <br />Limits- <br />$210, 000 <br />$ 55, 000 <br />540,000 <br />General Aggregate <br />Products - CompOp Agg <br />Personal & Adv Injury <br />Each .Occurrence <br />Fire Damage (Any One. Fire) <br />Med Exp (Any One Person) <br />$2.000,000 <br />$1,000.000. <br />S1,000,000 <br />$1,000.000 <br />$50,000: <br />$1,000 <br />81 Each Person: <br />81 Each Occurrence: <br />PO Each. Occurrence: <br />$100,00a <br />$1p0,oac <br />$1:00;000 <br />Loss .of Means of Support Ea.:Person: $.100,000 <br />Loss of Means of .Support Ea Dec:. . $.100,000 <br />.Comb. Policy Agg Limit: S300,000 <br />Coinsurance: <br />90% <br />90% <br />114 Limitation <br />Forrn: <br />Special/RC <br />Special/RC <br />Deduc lib{e' <br />$500 <br />$500 <br />LOCATION( OF RISK <br />❑ESCRIPTION OF RiSK[ <br />3500 Hoffman: Road W. Gem Lake, MN 551 1.0 <br />Tavern <br />(Certificate Haider <br />Cancellation <br />y of Gern Lake <br />r.200 Otteiiake Rd <br />White Bear Township, MN 55110 <br />Fax 651-426-2258. <br />Should any of the described policies be canceltecl before.tha expiration dale <br />(hereof, the issuing company will endeavor .fo Mal 10 days mitten notice of <br />cancellation to thecerfificateholder na ned to the left, but failure to mail such <br />nolice shall impose no obligation or 'ability of any kind upon the company, its. <br />agents or representatives. <br />Authorized . Representative <br />�•i5 •F r �. <br />,¢ Holm bnsmntlaotcom. <br />