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cord II�iI <br />I. <br />YAMI AN11 AI10111 SS (11 Afl Nf9 <br />A.I,C,s„ Inc. <br />P. p, Ito:,, 2029 <br />j.s t. Paul# MIN 55109 <br />NAME AND ADDR15$ IN INSURLD <br />•�-r.--'M1= a""T�"r'oliin <br />5394 Ldg1:4iilid'Dr. <br />Moundsview# MN 55112 <br />UMPANV I IVII JN INSAIIANII <br />Jill" <br />UOMPNENENSIVE FORM <br />PRIMISLS—OPERATIONS <br />(APLOSION AND COLIMSE <br />tAIARD <br />UNDI INUN111NII IMIAIID <br />IN 011HAIlONS 1161AREI <br />CnNIRACTUAL INSURANCI <br />UNDID IORM PliUl'tR11 <br />DAMAGE <br />INDIIYNII(BI CONTRACIO <br />KITSONM INJURY <br />RMIMmUul.. .......... <br />❑ COMPKIIINSIV[ 1D111A <br />❑ ONNIV <br />❑ mmn <br />❑ NUN 01111111- E%CESS LIABILITY <br />❑ UNPRIILA FORM <br />❑ or III It I TAN UMDIN I IA <br />FORM _ <br />w R%ERS'COMPENSATION <br />and <br />EMPLOYERS' LIABILITY <br />OTHER <br />A Liquor Liabil ty <br />:exmlTION Or OMRATIONM o1.APLI-11111E1 rs <br />IYII A Y 14"Mil N <br />GA 32688 <br />COMPANIES AFFORDING COVERAGES <br />wNIPANI �L <br />_n_ininoie_FmR—Lu <br />r.11M1'ANY D <br />1111IR D <br />CONAWAY <br />11 llllr <br />nMl'NII D <br />COMPANY <br />maynperVln'Lha^nsmance e1N01rdded at thelP011613 <br />LirnuO A <br />01 V <br />I AMINO,," IIAI I <br />1-1-84 <br />NOWLYINJURY f <br />PNOPIRIYDAMAGE f <br />DoUltYINJURYAND <br />PROP[RTYDAMAG( f <br />cuMDIN[D <br />1'11150NA1 IMlI1NY <br />IultID Y INJURY f <br />II M:II All ININI <br />BODILY INJURY f <br />(I ACH ACCIDENT) <br />PROK111Y DAMAPE f <br />NUNN Y R julif AND f <br />IRNIP[NTY DAMAGE <br />COM111NIO <br />IWDII Y IhAIBY AND <br />PROPIRIYDAMAGE f <br />COMBINED <br />SIAIUI041 <br />fubiect la <br />AGGREGATE <br />f <br />f <br />f <br />f <br />® 3 Itx.KCd <br />$500# Bodily Inj. 1 piers <br />$500# Bodily Inj. 1 Occe <br />ing com- <br />Cancellallonl Should a y 01 the <br />above ldt scribed days lies U noleclelo the below ne the amed cert I cration date aterholder1. but failure o <br />mail such notice shall impose no obligation or liabillly of any kind upon the company. <br />NAME AND ADVIdSSOr IT All IIFXAI( IIOL IN 11 <br />City of Mounds View <br />2401 N.E. tiwye 10 <br />New Brighton, MN 55112 <br />DATE <br />--'•�11151 NIAiIVE <br />