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Acc>RhI' CERTIFICATE OF LIABILITY INSURANCE FDATE,/16/20YVYY) �� 05I1812022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONIACT TamiHowarter NAME: Corporate 4 Insurance Agency, Inc PHONE (952) 893-9218 A (952) 893-9402 AIC Na 7220 Metro Boulevard IIIADDRESS; tamih@corporatefour.com INSURERIS) AFFORDING COVERAGE NAIC p Edina MN 55439-2133 INSURERA: Illinois Casualty Company _ 15571 INSURED INSURER B : Security National Ins Co 19879 Moe's of Moundsview, Inc INSURER C : DBA: Moe's Restaurant INSURER D ; 2400 Moundsview Blvd INSURER E Moundsview MN 55112 INS URER F: COVERAGES CERTIFICATE NUMBER: CL2261677779 REVISION NUMBER: THIS IS TO CERTIFY THAT 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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LTR TYPE OF INSURANCE AWL W bVI3H POLICY NUMBER JMMIDDfYYYYJ IMMIODfYYYYI LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR _ EACH OCCURR[IJCE 3 1 000,000 PUREMIStS IEB rr $ 100,000 MED EXP An one oersonl $ Excluded PERSONAL RADVINJURY S 1,000.000 A BP35343 07101/2022 07/01/2023 GEWILAGGRE^GATE LIMIT APPLIES PER: POLICY dECOt LOC GENERALAGGREGATE s 2,000,000 PRODUCTS• COM PIOP AGG $ 2,000,000 $ OT1rPR AUTOMOBILE LIABILITY M I SI 07-cmT 5 ococknui $ 1,000,000 BODILY INJURY(Per person) $ ANYAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS BP35343 07101/2022 07/01/2023 BODILY INJURY (Per odenq $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 1 PROPERTY DAMAGE S $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ eXCFSS LIAB DED RETENTION $ $ WORKERS COMPENSATION PER OTH- B AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA SWC1344326 07101/2D22 07/01/2023 TA.7 7E .R EL EACH ACCIDENT _ $ 1,000,000 E.L DISEASE - EA EMPLOYEE $ 1,000,000 E.L DISEASE- POLICY LIMIT $ 1,000,000 A Liquor Liability LL97046 07/01/2022 07/01/2023 Each Common Cause Aggregate $1,000,ODO $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) Off Premises Catering Operations Included. Thirty day notice of cancellation with ten day notice for non payment CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Moundsview ACCORDANCE WITH THE POLICY PROVISIONS. 2401 Hwy 10 AUTHORIZED REPRESENTATIVE Moundsview MN 55112 © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD