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%._ O CERTIFICATE ®F LIABILITY INSURANCE DATE (MMIDD �--� 12/13/2013013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certlficate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed, If SUBROGATION 15 WAIVED, subject to the terms and conditions of the policy, certaln policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Karen Hawkinson NAME: Blakestad/Phenow, Inc. PHONE ,, (763)574-7447 FAX No 17631574-7509 6875 Highway 65 NE ennwlccckhawkinson@blakestad.com Fridley MN 55432 INSURED Gem Lake Hills Golf Course 4039 Scheuneman Road INSURERS) AFFORDING COVERAGE NAIC # :Secura Insurance i22543 C: INSURER E : --I Gem Lake MN 55110 INSURER F: r nvFRAnFS CERTIFICATF NIIMRPR-CL13121301 572 oC\nclnAr RuIRA— THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ICTR TYPE OF INSURANCE POLICY NUMBER MMroDMlYY MMfDDYNVYY LIMITS GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000. ){ COMMERCIAL GENERAL LIABILITY DAMAI O o.nuUn $ 300,000 A CLAIMS -MADE r_x1 OCCUR X "P3193856 1/1/2014 12/31/2014 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: _X-1 PRODUCTS - COMPIOP AGG S 2,000,000 POLICY PRO - FLOC S AUTOMOBILE LIABILITY N1 DI SINGLE LIMIT11000,000 F A X ANY AUTO BODILY INJURY (Per person) S OWNED SCHEDULED ALL OW 3193857 /1/2014 2/31/2014 BODILY INJURY (Per accident) S NON -OWNED HIRED AUTOS AUTOS PROPERTY AMAG p r n S Underinsured motorist $ 1,000,000 X I UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAR AGGREGATE $ 5,000,000 DED I X I RETENTI NS 10,00( S X FU3193859 1/1/2014 12/31/2014 A WORKERS COMPENSATION X WC 6TATU- OTH- AND EMPLOYERS' LIABILITY YINIrR L319385B E.L. EACH ACCIDENT S 500,000 ANY, PROPRIETOR/PARTNER)EXECUTIVE � NIA OFFCERIMEMBER EXCLUDED? I`� in NH)E.L. 1/1/2014 12/31/2019(Mandatory DISEASE - EA EMPLOYE $ 500000 11 yes, describe under E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS below A ( Liquor Liability CP3193856 1/1/2014 2/31/2014 Each Common Cause 1,000,000 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is roqulred) Certificate holder is listed as additional insured- CEK I IFIGA I t INUL (651)426-2258 GANGtLLA I IUN patti . wal s tad@ ci . white—bea I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Gem Lake ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Patty S Walstad 4200 Otter Lake Road Gem Lake, MN 55110-3227 ACORD 25 (2010105) INS025 1gmnnat m AUTHORIZED REPRESENTATIVE Larry Ward Ltd/KARH U Ty88-2U9U ACORD CORPORATION. All rights reserved. TF.n Ar.npn name and Innn ern —mictnr-1 mnr4c nF A(:r1Rrl