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17,414,411111 <br />�.. <br />Quality Insurance Service <br />1646 Rirc street <br />,9I., Paul, Nil 55117 <br />INIURED <br />.....,....."",,.. _.. <br />PELNAR, KATHLEEN <br />6S4 6th 6't N <br />Hudson, WY 54016 <br />DATE INN DDIVYYYI <br />tl2/20J2606 <br />A MATTEROF INFORMATION <br />TS UPON THE CERTIFICATE <br />68 NOT AMEND EXTEND OR <br />ED BY THE OL OIES. BELOW, <br />in li.au 0AIC# <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, <br />NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE <br />MAY BE <br />ISSUED OR <br />MAY PERTAIN, THS INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALI, THE TERMS, EXCLUSIONS ANO CONDITIONS OF, SUCH <br />POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INER AOo'Li POLICY NUMBE0. O61DY . 11 Pg1,i0Y@A�� pj] r <br />JkAmnr CONTIATP rN I , <br />—^••--- <br />LIMITE <br />r CSNEAAL LMB614Y <br />I-• <br />EACH OOCURRENCE <br />� <br />5Do DOD <br />A I„x COMMERCIAL G9N6RAl LIABILITY CF46123Q 04/17/2DQ5 Q4 /17/2006 <br />_. <br />p lea rra�9 ut� un <br />a <br />aoa� 000 <br />CLAIMS MADE (OCCUR <br />MED EXPAn om prrPDnI <br />i <br />51 000 <br />- <br />PERSONAL 4 ADV INJURY <br />1 <br />—_` <br />SO0, 000 <br />... ..—• <br />0ENERALAGGR6GATE <br />S <br />500,000 <br />aEN1 AGOREOATEr LIMIT APPLIES PER! <br />_ <br />PRODUCT$• COMPIOP AMC <br />S <br />Soo 000 <br />POLlOV T rfLOC <br />tAUfOMOBILE UASILITY <br />,_ <br />B ANYAUTO <br />CA 1225559 <br />06/24/2005 <br />00/24/2006 <br />ODM9INSP $INGLELIMIP <br />($i 6%,11 <br />—' <br />$ <br />500, 000 <br />' ALL OWNED AUTOS <br />I <br />j •,) SCHEDULED AUTOD <br />SONLY INJURY <br />(per Pels") <br />1 <br />j HIRED AUTOS <br />'- <br />^ <br />I <br />I •, NON -OWNED AUTO$ <br />RY <br />(erOeoDWerul <br />PROPERTY DAMAGE <br />1 <br />.. I .. .... .......... ... ».�,..__—.- <br />(Per e09109M) <br />pARAOE LIABILITY <br />r ^ ^• <br />AUTO ONLY • Ea aCCIOENT <br />; ANY AUTO <br />OTHER THAN EA ROG <br />S <br />/ <br />� <br />AUTO ONLY: ADD <br />AXOESEIUM9R9LLA Yjk.91LITY <br />i" <br />- <br />EACH OGCURRENCE <br />E <br />OCCUR ., CLAIMS MADE <br />AG@R$OAT11 <br />y <br />^-- <br />i <br />I ' PepUCTi@66 <br />' <br />E^ <br />I RETENTION 1 <br />--^—'- <br />1 <br />I WORREAB OOMPEN$ATRIN AND <br />PT $TAT <br />� EMPLOV$RE41Ag1urY <br />E.L. EACH ACCIDENT <br />i <br />ANY PROPRIEtORJPARiN9PlEAECVTIVE <br />OFFICERAMEMBER EXCLVOE07 <br />E.f. OI66ASB•6A 6MPLpYE <br />1 <br />IIP 1010V <br />CIA PIA100, <br />VIDIONS EelDw <br />E.L. 0169AS9•POLICY LIMiT <br />—�_ <br />E <br />OTHER <br />PEBCRIPTIOH OF PPiRAT1ONE r LOCATIONi I V@HIp609 / ■ROLWIONi ADDED BY SHOOR20MONT I BFEWAL PAO"810NE <br />FP:CTICIM AYG uN AGb _..._.. . <br />City of Lake Elmo <br />300) Lav@rne Ave. <br />Lk, Elmo, MR 55042 <br />715-1E6-0925 <br />BNOVLD ANY OF THE AROVE 09/0111860 POLICIES 99 DARDELLBD GEFOAE THE ESPIKATION <br />DATE THORBOP, THE 1EEVIN6 IROUROR WILL 9NOEAVON TO MAIL =10 DAYS WAIT19N <br />NOTICE TO THE OEATIFYDATE ROWER NAMED TO THE LEFT, BUT FAILUR9 TO DO $0 SHALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON TKE INSURER, IN 499NTe OR <br />i 'd 9890'QN 8O M P 199 Wdg1:9 900z 'Bl'gBd <br />