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DATE ail
<br />AC;`ORD CERTIFICATE OF LIABILITY INSURANCE
<br />TA4 08 10/30/2007
<br />PRODUCER LOCKTON C0MPANIES,LLC--K CHTCAGO
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />525 W. Monroe, Suite 600
<br />HO LDER.'TI-1 1 S CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />CHICAGO IL 60661
<br />ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW.
<br />(312) 669-69010
<br />INSURERS AFFORDING COVERAGE
<br />NAIC 4
<br />INSURED Roundy's Supermarkets., Inc.,
<br />INSURER & TTavc[crs Property Casualty Ca of America
<br />2567•
<br />1075035 Attn. him Stenstrain
<br />INSURER Bil 01d, Republic Insurance- Company
<br />24147
<br />PO Box 473, MS, 23�00
<br />q -
<br />INSURER Q
<br />Milwakce W153201
<br />INSUIRER 0-.
<br />INSURER S:
<br />,COVERAGES ROUSU01 Cl
<br />THIS CERTIFICATE OF INSURAINCE DOES NOT CONSTff UTF- A CONTRACT HStWEEN THE ISSUING
<br />INSURER (s), AuTmowm REPR#.$ftk-VA11VF- OR PRODUCER ANDTHE CPWONCAte HOLDER.
<br />THE POLICIES OF IIINSIUIRANCIE LISTED, BELOW' HAVE BEEN ISSUED TO THE
<br />INSURED. NAMED A13OVE FOR THE POLICY PERIOD iNDICATED, NOTWITHSTANDING
<br />ANY REQUIRLMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUIMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
<br />MAY PERTAIN, THEI IN I'll N'CIE AFFORDED BY THE POLI C IES DESCRI BE D HEREIN IS SUBJECT'T'O ALL. THE TERMS, EXCLUSIONS AND CONDITI
<br />ONS OF SUCH
<br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REOLICED BY PAID CXAIMS.
<br />INSR
<br />t.TR
<br />ANY
<br />WSR4
<br />TYPE OF INSURANCE
<br />POLICY NUMBER
<br />I
<br />POLICY EFFECVVE.
<br />DATE JMMIDD"i
<br />POLICY EXPIRATION
<br />VATE MM00
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE S
<br />1,000,000
<br />A
<br />X',
<br />COMMERCIAL GENERAL LIABILITY
<br />TJ-EXGL-1 171)833A-TII-07
<br />I 1 1 /20�07
<br />12/112008
<br />DAMAGE TO RENTED S
<br />PREMISES (F-9 occurencel
<br />4000,000
<br />CLAIMS MADE 0 OCCUR
<br />MED-E-X.P (Any Dne person) S
<br />XXXXXXX
<br />PERSONAL & ADV INJURY $
<br />1 P000,000
<br />GENERAL AGGREGATE $
<br />10,000,()00
<br />GEN't, AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMPIOP AGG S
<br />2j000,000
<br />POL ---J� RO,- O
<br />n ICY I, PJECT F�LC
<br />AUTOMOBILE LIA81LrrY
<br />COMBINED SINGLF LIMIT'
<br />XXXXXXX
<br />ANY AUTO
<br />NOT 'APPLICABLE
<br />(Ea accident)
<br />ALL,, OW'NED AUITOS
<br />BODILY INJURY
<br />XXXXXXX
<br />SCHEDULED AUTOS
<br />(Per person)
<br />HIRED AUTOS
<br />BODILY INJURY
<br />XXXXXXX
<br />NON-OWNED, AUTOS
<br />(Per accidenO
<br />I
<br />H
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />XXXXXXX
<br />GARAGE
<br />LIABILITY
<br />AUTO ONLY - EA ACCIDENT S
<br />XXXXXXX
<br />ANY AUTO
<br />NOT APPLICABLE
<br />OTHSk THAN FA ACC $
<br />XXX'XXXX-
<br />AUTO ONLY; AGG S
<br />XXXXXXX
<br />EXC�ESSIUMBRELLA LIABILITY
<br />EACH OCCURRENCE S
<br />XXXXXXX
<br />OCCUR QLAWS MADE
<br />El
<br />NOT APPLICABLE
<br />AGGREGAYE 5
<br />XXXXXXX
<br />$
<br />XXXXXXX
<br />0 UMBRELLA
<br />H
<br />DEDUGTI814EF FORM
<br />$
<br />XXXXXXX
<br />RETENTION $1
<br />F
<br />$
<br />XXXXXXX
<br />X I WC STATU- OTH-
<br />B
<br />WORKERS COMPENSATtON AND
<br />MWC 11539.1 00
<br />12/1/201071
<br />t2/l/2008
<br />ATORY LIM;TS ER
<br />EMPL,OYERS'LIA,B,ILFrY
<br />51. 5ACH ACCIDENT S
<br />1,000,()00
<br />ANY PROPRIIETOR/PART,NERiEXE�C-�01-riVE
<br />OFFICERIMt-MBEREXCLUDED? N01
<br />E.L. DISEASE - EA EMPLOYEE S
<br />1,000,000
<br />If ens descfibe under
<br />S ECIAL PROVISIONS helow,
<br />El, oiSPA8E - POLICY LIMIT S
<br />100,000
<br />A
<br />OT ,EP,
<br />*rJ-EXGL- I 17D833A-Til.07
<br />I 111 /201071
<br />1211/2008
<br />$1,000,000 each common causc.
<br />Liquor Liabificy
<br />11
<br />-F ----------
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED 13Y ENDORSEMENT I SPECtAL PROVISIONS
<br />I
<br />Policy expiration dates shown above will advance successively upon each annual renewal
<br />-
<br />date. RBF, LLC of Wisconsin dba: Rainbow Foods Re. Rainbow Foods
<br />48854 1643 County Road B2 Roseville, " 5511 -3 ) Rainbow Foods 08826 1201 W.
<br />LarpCinlbus• Ave Roseville, NfN 55113
<br />CERTIFICATE HOLDER CANCELLATiON
<br />21708270 SHOULD ANY OF' THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br />City of Roscvillic, Minnesota DATE THEREOF, THE ISSUING INSUREIRWiLt. ENDLAVORTO MAIL 30 LAYS WRITTEN
<br />2660, Civic C'eniit,eT Dirivt NO,TIC�E TO THE CERTIFICATe HOLDER NAMED TO THE LEFT, BUT FAILURF- TO 00 So SHALL
<br />Roseville MN 55113 IMPOSE NO OBLIGATION OR. LIABILITY 05 ANY KIND UPON THE INSURER, ITS AGENTS OF
<br />REPRESENTATIVES,
<br />AUTHP -
<br />,!IZED,
<br />ACO,RD 25 (20101/08) For quevtloris vagarding LhIk certiffeate, contact the 03umber 11sted in thd'Produceir* sactlan above an*709rifY the r-Ilant code `R -OuSU-01. b-A RD CORPORATION 1988
<br />
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