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CERTIFICATE OF COVERAGE STATE OF MINNESOTA Risk Management Division 309 Administration Building 50 Sherburne Avenue St. Paul, MN 55155 (651) 284-3865 This is to certify that coverage described below is effective per the statutory authority referenced. This certificate is not a policy or a binder 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 terms and conditions of the statutory authority. STATE AGENCY: Location Name (If applicable) Minnesota State Fair Minnesota State Fairgrounds 1265 Snelling Avenue North S1. Paul, 11N 55108 Date Issued: August 1, 2001 xx TYPE OF COVERAGE LIMITS Automobile Liability $300,000 Bodily Injury & Property Damage - per Person! XX ~Owned, Hired & Non-Owned $1,000,000 Bodily Injury & Property Damage - per Occurrence ~Automobi1e Physical Damage Comp & Collision) $500 Deductible $300,000 Bodily Injury & Property Damage - per Person! XX General Liability $1,000,000 Bodily Injury & Property Damage - per Occurrence Other The entry of an XX in this column means that the coverage is afforded per this certificate and the statute(s) referenced below. STATUTORY REFERENCES Automobile Liability - Minnesota Statute 65.B Self-Insurance Number is A-I 046 as assigned by the MN Department of Commerce General Liability - Minnesota Statutes 3.732 and 3.736. Workers' Compensation - Minnesota Statutes Chapter 176 Sections 5401-611 DATES OF COVERAGE: July 01,2001- September 10, 2001. DESCRIPTION OF COVERAGE: Evidence of insurance for the Minnesota State Fair Fair dates: August 23, 2001 through September 3, 2001- ISSUED TO: ISSUED BY: RISK MANAGEMENT DMSION St. Rose of Lima Church c/o Father Walter Sochacki 2048 Hamline Avenue St. Paul, MN 55113 Certificate Number: 2001 - 13 Y!Ji~ 4Jtl/lt/;ifX-~~ AUTHO SIGNATURE