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PRODUCER <br />CERTIFICATE OF INSURANCE <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND <br />CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE <br />DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE <br />POLICIES BELOW. <br />LGaiiIN R. SERVICES <br />F. O. ) GI: 'Ii V67T <br />KANSAS CITY, NC 64141-0679 <br />INSURED <br />!RCLE-LEX VFa POST 16583 <br />-/S6.8 LAKE uRIvE <br />LINO LAKES, Ihty 550t <br />ISSUE DATE (MM/DD/YY) <br />COMPANY A <br />LETTER <br />COMPANY B <br />LETTER <br />COMPANY C <br />LETTER <br />COMPANY D <br />LETTER <br />COMPANY E <br />LETTER <br />COMPANIES AFFORDING COVERAGE <br />GOLF Ii1:L•hii,^i%E COIiF'ir,. <br />COVERAGES <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />CO <br />,LTR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE POLICY EXPIRATION <br />DATE (MM/OD/YY) DATE (MM/DD/YY) <br />LIMITS <br />GENERAL LIABILITY <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE OCCUR. <br />OWNER'S & CONTRACTOR'S PROT. <br />GENERAL AGGREGATE <br />PRODUCTS-COMP/OP AGG. <br />PERSONAL & ADV. INJURY <br />EACH OCCURRENCE <br />FIRE DAMAGE (Any one fire) <br />MED. EXPENSE (Any one person) $ <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />GARAGE LIABILITY <br />COMBINED SINGLE <br />LIMIT <br />BODILY INJURY <br />(Per person) <br />BODILY INJURY <br />(Per accident) <br />PROPERTY DAMAGE <br />$ <br />$ <br />EXCESS LIABILITY <br />UMBRELLA FORM <br />OTHER THAN UMBRELLA FORM <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />WORKER'S COMPENSATION <br />AND <br />EMPLOYERS' LIABILITY <br />STATUTORY LIMITS <br />EACH ACCIDENT <br />DISEASE—POLICY LIMIT <br />DISEASE—EACH EMPLOYEE <br />$ <br />$ <br />OTHER <br />r: LIIfUGR LIAB:LIT( <br />CLF 7C, ti 86-C <br />NPR <br />AGGREGATE <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS <br />- CERTIFICATE HOLDER <br />..:,.i if iCA E 0127:00064j <br />CH"; GF LINO LAKES, ii <br />I'. AAIN STREET <br />LNG LAKES, <br />ACORD 25-S (7/90) <br />CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO <br />MAIL !I. DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE <br />LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR <br />LIABILITY OF ANY IND UPON THE ' •MPANY, ITS AGENTS OR REPRESENTATIVES. <br />AUTHORIZED REP <br />©ACORD CORPORATION 1990 <br />