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<br /> <br />CERTIFICATE OF COVERAGE <br />STATE OF MINNESOTA <br />Rjsk Management Division <br />309 Administration Building <br />50 Sherburne Avenue <br />St. Paul, MN 55155 <br />(651) 284-3865 <br /> <br />This is to certify that coverage described. below is effective per the statutory authority referenced. This certificate is not a policy or a binder <br />of insurance and does not in any way alter, amend or extend the coverage afforded by any reference herein. The coverage is subject to all <br />terms and conditions of the statutory authority. <br /> <br />STATE AGENCY: Location Name (If applicable) <br />Minnesota State Fair Minnesota State Fairgrounds <br />1265 Snelling Avenue North <br />St. Paul, :tv1N 55108 <br /> Date Issued: August 1, 2001 <br /> <br />xx ItrYPE OF COVERAGE LIMITS <br /> iAutomobile Liability $300,000 Bodily Injury & Property Damage - per Person! <br />XX r-ll-Owned, Hired & Non-Owned $1,000,000 Bodily Injury & Property Damage - per Occurrence <br />-X..-Automobile Physical Damage <br /> Comp & Collision) $500 Deductible <br /> . <br /> $300,000 Bodily Injury & Property Damage - per Person! <br />XX General Liability $1,000,000 Bodily Injury & Property Damage - per Occurrence <br /> Other <br /> <br />The entry of an XX in this column means that the coverage is afforded per this certificate and the statute(s) referenced below. <br /> <br />STATUTORY REFERENCES <br /> <br />Vlutomobile Liability - Minnesota Statute 65.B Self-Insurance Number is A-I 046 as assigned by the MN Department of Commerce <br />General Liability -Minnesota Statutes 3.732 and 3.736. <br />Workers' Compensation - Minnesota Statutes Chapter 176 Sections 5401-611 <br /> <br />DATES OF COVERAGE: <br /> <br />July 01, 2001 - September 10, 2001. <br /> <br />DESCRIPTION OF COVERAGE: Evidence of insurance for the Minnesota State Fair <br />Fair dates: August 23, 2001 through September 3, 200l. <br />ISSUED TO: ISSUED BY: RISKMANAGEMENTDIVISION <br />Grace Church of Roseville <br />c/o Dawn Clifford <br />1310 W Co Rd B2 <br />Roseville, MN 55113 <br /> <br /> <br />Certificate Number: 2001 - 15 <br /> <br />Yt1a1~ tJtlltUMftVL/ <br />AUTHOIZ. SIGNATURE <br />