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^� CERTIFICATE OF LIP
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONL
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITL
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the
<br />the terms and conditions of the policy, certain policies may require an e
<br />certiiicate holder in lieu of such endomemen s)
<br />PRODUCER
<br />Park Valley Young Agency
<br />7054 E Fish Lake Road
<br />Maple Grove, MN 55311
<br />INSURED
<br />Kerry Gerard
<br />DBA Soda Tap House and Grill
<br />2535 County Highway 10
<br />Mounds View, MN 55112
<br />B I L ITY INSURANCE DATE (MMIDDNYYY)
<br />02-26-2020
<br />(AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />rE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />Policy(lies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />idorsement. A statement on this certificate does not confer rights to the
<br />A....— Michael Dotter
<br />PH H 1E 763-463-0100 AX e. 763-463-0105
<br />E'A1Ali, mike@perlcvalleyyoung.com
<br />INSURERS RFFQRDfHG COVE GS< NWCd
<br />INSURERA; Badger Mutual Insurance
<br />INSURERS; Midwest Insurance
<br />INsuRetx c
<br />INSURER D:
<br />IN$UR E'
<br />INSURER F
<br />COVERAGES CERTIFICATE NUNimr-M, REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUE] TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOT W(THSTANOING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POL1CiES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS.
<br />IADDLISUORT—
<br />TYPE OF INSURANCE POLIGY B MMFODYEFF Pp �CDY E%P LIMITS
<br />GENERAL LIABILITY
<br />X
<br />EACH OCCURRCNCE
<br />$
<br />1.000,000.00
<br />COMMERCIAL GENERAL LIABILITY$
<br />1ao,oaD
<br />"MS -MADE OCCUR
<br />A Y Y
<br />MP514433
<br />03/23/2020 03/23/2021
<br />MED EXP one on
<br />PERSONAL&ADV1NIURY
<br />$
<br />S
<br />5,000
<br />1,000,000.00
<br />GFRERAL AGGREGATE
<br />$
<br />2,000,000.00
<br />GEN'LAGGREGATE LIMITAPPLILS PER:
<br />PRODUCTS •COMP/OP AGG
<br />S
<br />2,000,000.00
<br />POLICY PRO -
<br />F_1 IF LOC
<br />AUTOMOBILE LIABILITY
<br />BI D MULE I
<br />2,1=12V
<br />1,000,000.60-
<br />AUTO
<br />A ALL OWNED SCHEDULED
<br />A
<br />BODILY INJURY (Per person)
<br />$
<br />1,000,000.00
<br />AUTOS AUTOS
<br />MP514433
<br />03/2312020 03/23/2021
<br />BODILY INJURY (Per accident) $
<br />14000,000.00
<br />WIN
<br />X WNED
<br />HIRED AUTOS X gUTO
<br />PROPERTY AG
<br />S
<br />1,000,000.00
<br />X UMBRELLA LUIB
<br />OCCUR
<br />A
<br />EACH OCCURREHCIE
<br />S
<br />1,000,000.00
<br />EXCESS LIAR OWIIMS kLIAE
<br />MP514433
<br />03/23/2020 03/23/2021
<br />AGGREGATE
<br />e
<br />4 X RETENTIONS 10,000
<br />WORK MS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />YUC STRTtr-
<br />PTH• X
<br />$
<br />Y / N
<br />B Yt�aOJPNRE1MeERR1A�v4� fCLnrvE
<br />p N 1 A
<br />100402173
<br />03/23/2020 03/23/2021
<br />F -L EACII ACCIDENT
<br />Is
<br />(Ma In NHy
<br />If yW, daatY64nor /'hd wider
<br />E.L. DISEASE - EA EMPLO
<br />$
<br />DES RIPTION OF OPERATIOM boknv
<br />E. L. DISEASE -POLICY LIMIT
<br />13
<br />Liquor Liability
<br />A
<br />MP514433
<br />03/23/2020 03/23/2021
<br />$1,000,000.00 Per Occurrence
<br />$1,000,000.00 Aggregate
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach
<br />ACORD 101, Additional Remarks Schedule, If more space Is required(
<br />Family style restaurant and bar,
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />City of Mounds View
<br />2401 Mounds View Blvd.
<br />Mounds View, MN 55112
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTA
<br />Ott
<br />Michael Dotter
<br />ACORD 25 (2010105) 01988-2010 ACORD CORPORATION. All rights reserved.
<br />z
<br />The ACORD name and logo are registered marks of ACORD
<br />X,t,✓V t,4A exp ,�?,,� Y u"oyL A, . z - ;L-& `Aero �
<br />
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