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ALc a CERTIFICATE OF LIABILITY INSURANCE DTE (MMM 016Y) 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(les) 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 NAME: Lucas Olson Christensen Group insurance 11100 Brea Road West PHONE E% (952)653-1000 FAX No: (952)653-11011 A DRE s: lolsonWchriatensengroup.com INSURI AFFORDING COVERAGE NAIC 4 INSURERA:NSI - A Division of West Bend 22608 Minnetonka MN 55343 INSURED INSURER B Hugo Lions Club INSURER C: INSURER D: PO BOX 321 INSURER E Hugo MN 55038 INSURER F: COVERAGES CERTIFICATE NUMBER:16-17 Liab 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. INSR LTRjhlaa rypE OF INSURANCE ADDL SUER J= POLICY NUMBER POLICY EFF MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE R�OCCUR EACH OCCURRENCE $ 1,000, 000 DAMAGETORENTED 100,000 PREMISES Ea occurrence $ MED I(Any one person) $ EXCLUDED A108567 1/1/2016 1/1/2017 PERSONAL B ADV INJURY $ 11000,000 GERI AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ PRO ECT D LOC PRODUCTS - COMP/OP AGG $ 2,000,000 I Additional Insured $ OTHER' r AUTOMOBILE LIABILITY COMBINED SINGLE UI 7 - Ea accident) BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accitlent $ ( ) NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ Per accitlent UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS ICLAIMS-MADE DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN I PER OTH- STATUTE ER EL EACH ACCIDENT $ ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑NIA E.L. DISEASE - EA EMPLOYE $ (Mandator, in Ni If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A LIQUOR LIABILITY A108575 1/1/2016 1/1/2017 EACH COMMON CAUSE $110001000 AGGREGATE $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required) RE: Wilson Tool Picnic at the Hanifl Fields, 7032 137th Street North, on Saturday, August 13, 2016 Certificate Holder is included as an Additional Insured lender the Commercial General Liability and Liquor Liability when required by written contract. MLindau@ci.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/LNO n foRR.2ntaArnan cnoonoennu eu rinHle rne.,..,..a ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401)