07-27-2005 Council Agenda - Laserfiche WebLink

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MINNESOTA LIQUOR LIABILITY ASSIGNED RISK PLAN MINNESOTA JOINT UNDERWRITING ASSOCIATION PIONEER P.O. BOX 1760 ST. PAUL, MN 55101 -0760 (651) 222-0484 or 1- 800 -552 -0013 CERTIFICATE OF INSURANCE FOR LIQUOR LIABILITY COVERAGE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THE CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE CONTRACT LISTED BELOW. POLICY NUMBER: LL05 -0606 CONTRACT HOLDER AND ADDRESS: DON BOWMAN SPORTSMEN CLUB, INC 2943 PAYNE N. LITTLE CANADA, MN 55117 CONTRACT PERIOD: 12:01 A.M. 8/19/2005 TO 12:01 A.M. 8/22/2005 SCHEDULED PREMISES: PIONEER PARK SOFTBALL COMPLEX, 2950 CENTERVILLE RD THIS IS TO CERTIFY PRAT THE CONTRACT OF COVERAGE DESCRIBED HEREIN HAS BEEN ISSUED TO THE CONTRACT BOLDER NAMED ABOVE AND IS IN FORCE AT THIS TIME. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN TO THE COVERAGE AFFORDED BY THE CONTRACT DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH CONTRACT. TYPE OF COVERAGE LIMITS OF LIABILITY BODILY INJURY PROPERTY DAMAGE LOSS OF MEANS OF SUPPORT ANNUAL AGGREGATE 50,000 100,000 10,000 50,000 100,000 300,000 EACH PERSON EACH OCCURRENCE EACH OCCURRENCE EACH PERSON EACH OCCURRENCE ANNUALLY SHOULD THE ABOVE CONTRACT BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE PLAN WILL MAIL 60 DAYS WRITTEN NOTICE TO THE BELOW NAMED CERTIFICATE HOLDER, HOWEVER, IN THE EVENT THE CANCELLATION IS FOR NON PAYMENT OF PREMIUM, THE PLAN WILL MAIL A 10 DAY WRITTEN NOTICE. CERTIFICATE HOLDER NAME & ADDRESS: MN DEPT OF PUBLIC SAFETY 444 CEDAR ST., STE 100 L ST PAUL, MN 55101 DATE OF ISSUE: 7/19/05 AGENCY NAME & ADDRESS THORIZ D RE ° :SENTATIVE