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DATE IMMDIYYYY] ® IDCERTIFICATE OF LIABILITY INSURANCE 05108123 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pDlicy(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 endorsements . PRODUCER CONTACT Kim L Brown KI M L BROWN I N C PHONE 651 730-9803 FA1C NO: 651 578-2427 PO Box 25407 E-MAIL kirn klbins.com Woodbury, MN 55125 INSURER(S) AFFORDING COVERAGE NAIC9 INSURED INSURER B: Maxx Bar & Grill INSURER C: Westy's Properties, Maxx Bar & Grill Inc INSURER D: 17646 Central Ave NE INSURER E: Ham Lake MN 55304 1 INSURERF: C_r7VFRAr.FR rFRTIFIrATF Id111MRFR• RFVISknPd NI IMRFR- 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. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS POLICY NUMBER MM7DDIYYY MMIDDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000000 CLAIMS -MADE X OCCUR 1A Al To RNTED PRE' M SES EaEoccurrence $ 50,000 MED EXP (Any one person) $ 0 PERSONAL & ADV INJURY $ 1000000 A BP22017176 07/01/23 07/01/24 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ zo000o0 POLICY JET LOC PRODUCTS -COMPIOPAGG $ 2000000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO A OWNED AUTOS ONLY AUTOSULED BP22017176 07/01123 07101 /24 BODILY INJURY (Peraccbdent) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE ❑E❑ I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y f N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) NIA WC,22017189 07101/23 07/01124 �/ OTH- X STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYE $ 500,000 IF yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -'POLICY LIMIT $ 500,000 A Liquor Liability T LL22a17178 07/01/23 07l01124 Occurence $ 500,000 Aggregate unlimited ❑ESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Extends coverage to Festival in the Park. Coverage is continuous until canceled. Coverage extends to all events on and off premise for food and liquor. CFRTIFICATF HC)I DFR CANCFI I ATION Attn: Katherine Smith SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Mounds View 2401 Mounds View Blvd THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Mounds View, MN 55112 AUTHORIZED REPRESENTATIVE barb.benescht<u7moundsviewmn.org 0�z464wV...) © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD