06-22-2005 Council Agenda - Laserfiche WebLink

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MINNESOTA LIQUOR LIABILITY ASSIGNED RISK PLAN MINNESOTA JOINT UNDERWRITING ASSOCIATION PIONEER P.O. BOX 1760 ST. PA1JL, 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 -0455 CONTRACT HOLDER AND ADDRESS: CONTRACT PERIOD: 12:01 A.M. 9/17/2005 TO 12:01 A.M. 9/17/2005 LITTLE CANADA RECREATION ASSOCIATION LCRA 515 E. LITTLE CANADA RD LI1 I LE CANADA, MN 55117 SCHEDULED PREMISES: PIONEER PARK, LITTLE CANADA, MN THIS IS TO CERTIFY THAT TEIE CONTRACT OF COVERAGE DESCRIBED HEREIN HAS BEEN ISSUED TO THE CONTRACT HOLDER 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 WRI1 1 EN 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/ LDCD DATE OF ISS 6/i 05 444 CEDAR ST., STE 100L ST PAUL, MN 55101 AGENCY NAME & ADDRESS RICK BOSS LCRA 515 E. LITTLE CANADA RD LITTLE CANADA, MN 35117 HORI YD R"rSENTATIVE