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. 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 TIC CERTIFICATE HOLDER. THE CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER TI-TE COVERAGE AFFORDED BY THE CONTRACT LISTED BELOW. POLICY NUMBER: LL05 -0454 CONTRACT PERIOD: 12:01 A.M. 10/29/2005 TO CONTRACT HOLDER AND ADDRESS: 12:01 A.M. 10/30/2005 LITTLE CANADA RECREATION ASSOCIATION LCRA 515 E. LI1 1LE CANADA RD, LITTLE CANADA, MN 55117 SCHEDULED PREMISES: 2621 MCMENEMY, ST JOHNS SCHOOL HALL, LC, MN THIS IS TO CERTIFY THAT THE 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 50,000 EACH PERSON PROPERTY DAMAGE $ 100,000 EACH OCCURRENCE LOSS OF MEANS OF SUPPORT $ 10,000 EACH OCCURRENCE $ 50,000 EACH PERSON ANNUAL AGGREGATE $ 100,000 EACH OCCURRENCE $ 300,000 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 LIQUOR CONTROL DIV., DEPT OF SAF DATE OF ISSUE' 6/15 444 CEDAR ST., STE 100L ST PAUL, MN 55101 AGENCY NAME & ADDRESS LITTLE CANADA RECREATION ASSOC, 515 E. LITTLE CANADA RD LITTLE CANADA, MN 55117 RIZE TATI V E