11-24-2004 Council Agenda - Laserfiche WebLink

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ACORD, CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YY) PRODUCER Jim Nesser AGeriC Inc. yr . 4175 Lovell Road #100 Lexington, Minn 55014 POLICY NUMBER 1 POLICY MM/ / THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION NLY AND CONFERS NO RIGHTS UPON -HE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED Chou C. Yang DBA: Tierney's Liquor 2760 N Rice Street Little Canada, Minn 55117 INSURER A: Safeco Ins Co INSURER B: Berkley Risk Adm INSURER C: INSURER D. INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R LT R TYPE OF INSURANCE POLICY NUMBER 1 POLICY MM/ / POLICY TE (MM /DDAYII DATE N LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY I MADE L _� OCCUR 1 EACH OCCURRENCE FIRE DAMAGE (Any one f re) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE $ 1 CLAIMS $ $ $ $ GEM_ AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP /OP AGG $ POLICY f PRO T LOC EC AUTOMOBILE ..__.I 1 IALL ' LIABILITY ANY AUTO OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ $ BODILY INJURY (Per accident) _ PROPERTY DAMAGE (Per accident GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY ! ! EACH OCCURRENCE $ IOCCUR I J CLAIMS MADE DEDUCTIBLE RETENTION $ AGGREGATE $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC22041039925 12 -13 -04 6 -30 -05 ! WCSTATU- 1 I TORYLIMITS I_ i ER OTH. D0.0 0.0 Q n 0 0 _, E.L. EACH ACCIDENT $ 10� E.L. DISEASE - EA EMPLOYE j $ 1 0 a $ S 0 0 E.L. DISEASE - POLICY LIMIT A OTHER Liquor Liability 02BP056266 112 -13 -04 6 -30 -05 Limit of Liability DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS b u u, 0 U U / 1, 0 0 0, 0 0 0 ADDITIONAL INSURED INSURER LETTER: CANCELLATION City fo Little Canada 515 E Little Canada Road Little Canada, Minn 551] ] SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE RE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL,7J DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ��, AUTHORIZED REPRESENTATIVE ` ACORD 25 -S (7/97)