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A� o CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYVYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 6/29/2016 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 policy(ies) must 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 CONTACT Lucas Olson NAME: Christensen Group Insurance 11100 eren Road West PRONE (952)653-1000 A N FANG No:(9-0 653-1100 EMAIL IL ADDRESS :lolson@christensen rolP•com INSURERS AFFORDING COVERAGE NAIC p Minnetonka MN 55343 INSURERA:NSI - A Division of West Bend 22608 INSURED INSURER B: Hugo Lions Club INSURERC: PO HOX 321 INSURERD: INSURER E CLAIMS -MADE IX OCCUR Hugo MN 55038 INSURER F: 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. ILTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MM OIYYYY POLICY EXP MM/DDIYY Y LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11.000,000 A CLAIMS -MADE IX OCCUR DAMAGE ( RENTED PREMISES Ea occurrence) $ 100,000 MED ESP (Any one person) $ EXCLUDED A108567 1/1/2016 1/1/2017 PERSONAL B ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 21000,000 X POLICY PRO - 1:1 F7JECT LOC PRODUCTS -COMP/OP AGG $ 2,000,000 Additional Insured $ OTHER I AUTOMOSILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident) BODI LY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS HIRED AUTOS ANONO-0WNED PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED I I RETENTION WORKERS COMPENSATIONRS' ANO EMPLOYERSIPARTNERV YIN LIILIPER=ACCIDENT STAT E. L. EACH ANY PROPRIETOR/ PARTNERIEXECUTIVE EXCLUDED? ❑ NIA E.L. DISEAIf (Mandatory (Mantlatoryin NH) yes, tlescrihe under E.L. DISEA DESCRIPTION OF OPERATIONS below A LIQUOR LIABILITY A108575 1/1/2016 1/1/2017 EACH COMMON CAUSE $1,000,000 AGGREGATE $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) RE: Tough Mudder event at Wild Wings of Oneka on Saturday and Sunday, July 16 and 17 Certificate Holder is included as an Additional Insured under the Commercial General Liability and Liquor Liability when required by written contract. hugo.mn.us City of Hugo Attn: Michele Lindau 14669 Fitzgerald Ave N Hugo, MN 55038 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Hendrickson/LMO �`�" �""'�'�""`-I"''�"'�I ©1988-2014 ACORD CORPORATION. All riahts reser.d ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401)