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DATE (MMIDDrcYYY)
<br />r ��"a CERTIFICATE OF LIABILITY INSURANCE
<br />12/14/2021
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT. If the Certlflcate holder is an ADDITIONAL. INSURED• tits poltcy(les) must have ADDITIONAL INSURES] provlstotls or ba andomed.
<br />If SUBROGATION IS WAIVED, subject to the terms and condNlons of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder In Ileu of such andoreemarlt(s).
<br />PRODUCER CONTACT NAME: Lauren Kachador(an
<br />_
<br />ESP Insurance Brokerage, LLC �IC � , (B77J 670.2377 �
<br />306 Main Street IC _ lai,rnn rrxrlraelnr,anfraen.,r. rnR.,,n,n
<br />Worcester
<br />INSURED
<br />TRIPLE SHIFT ENTERTAINMENT, LLC
<br />563 BIELENBERG DR STE 115
<br />Woodbury
<br />MA 01608 INSURERA:
<br />INSURER B
<br />INSURER C :
<br />INSURER D :
<br />INSURER E
<br />MN 55125 IoRbIngoa-
<br />Insurance Company
<br />COVERAGES CERTIFICATE NUMBER: CL21121412464 REVISION NUMBER: f
<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 RESPECTTO 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 />LTR TYPE OF INSURANCE MUM MIK POIJCY NUMBERPOLICY _ illMlW7�yynr� tMMR1 LIMITS
<br />.x COMMERCIALGENERALLIABILITY EACtI OCCURRENCE $ 1,000,000
<br />CLAIMS -MADE Fx_] OCCUR PR'MI - c $ 500,000
<br />MEDEXP An «roparson $ 5,000
<br />A SIBML02124-2i1 12l14/2021 T2H4/2022 PERSONAL aAOVINJURY I $ 1-000,000
<br />GE.M
<br />AWRE0A9E LIMITA,PPLES PER:
<br />---.
<br />POUCY u Cr
<br />ux.
<br />AUTOMOBILE LIABILITY
<br />ANYAUTO
<br />A
<br />OWNED
<br />AUTOS ONLY
<br />SCHEDULED
<br />AIIT01S
<br />HIRED
<br />AUTOS ONLY
<br />NON -OWNED
<br />AUTOS ONLY
<br />A ISC� EXCESS ABAB I I OCCUR
<br />WORKERS rOMPEARATION
<br />AND EMPLOYERS' LIABILITY Y I N
<br />ANY I'ROP6iETORIriARTNERf XK1)TIWF
<br />A' V PCER/MEMIMER E)CCUMED7 N N I A
<br />(Mandatory In NHI
<br />It ray, dezcnba under
<br />nESfYlfs�TlOIt OP OI%'RAT IONS below
<br />A Liquor Liability
<br />-- - -- -
<br />SIBML02124-211
<br />RIRFXn14R4-211
<br />— -
<br />12J14I2021
<br />12/14/2021
<br />-----
<br />-
<br />12/1412022
<br />12/14/2022
<br />GENERALAGGREGAIE
<br />1 2,000,000
<br />S 2,000,000
<br />PRODUCTS, COMPIOP AGG
<br />Fmployee Benefits
<br />$ IM/2M
<br />(_�Sddon• L L
<br />en
<br />$
<br />BODILY INJURY (Per person)
<br />$
<br />$
<br />BODILY INJURY (Per accident)
<br />A
<br />1
<br />1M Each Occurrence/
<br />s 1,000,000 Agg
<br />S 10,000,000
<br />T 1A,000,000 -
<br />s
<br />EACHOCCURR"E,NNr11
<br />AGGREGATE
<br />SISWC00742-211 12/1412021 12/14/2022 F-L FACHACCIDENT s 1,OD0,000
<br />E L DISEAASE• EAEMPLOYBC i 1,000.000
<br />E.L L SFASF • P%tQYJIM11 s 1,000,000
<br />T Each Common Cause 1.000.000
<br />SIBML02124-211 12/14/2021 12/1412022 Aggregate 2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more apace G required)
<br />Re: Mermaid
<br />Liquor; Intoxicating On -Sale License (Includes Sunday Sales and Outdoor Consumption)
<br />Restaurant
<br />Location- Mermaid 2200 Mounds View Blvd Mounds View MN 55112
<br />Liquor Liability and Workers Compensation insurance is continuous until cancelled
<br />[:f:I{TII-ICATC
<br />City of Mounds View
<br />2401 Mounds View Blvd
<br />Mounds View
<br />ACORD 25 (2015/03)
<br />Document Ref, A19GV-4X8VT-EKE84-IHYU2
<br />--- - � CANCELLATION --- ---- r
<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 REPRESENTATIVE
<br />MN 55112
<br />01988.2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
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