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AC" �® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/Y1YY) 04/30/2019 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 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 endorsement(s). PRODUCER CONTACT Nathan Lortz NAME: Christensen Group Insurance PHONE (952) 653-1000 FAX (952) 653-1100 A!C No Exi : (AIC.,, 9855 West 78th Street, Ste 100 E-MAIL nlortz@christensengroup.com ADDRESS: INSURERS) AFFORDING COVERAGE NAIC N INSDRERA: West Bend Insurance Cc 15350 Eden Prairie MN 55344 INSURED INSURER B : Hugo Lions Club INSURER C PO Box 321 INSURER D : INSURER E : Hugo MN 55038 INSURER F COVERAGES CERTIFICATE NUMBER: 19/20 Liab Cert 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDY� POLICY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE N OCCUR PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1,000,000 A A108567 01/01/2019 01/01/2020 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PEO LOC PRODUCTS-COMPlOPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILYINJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS A108567 01/01/2019 01/01/2020 BODILY INJURY (Per accident) $ x PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DIED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? N/A E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ LIQUOR LIABILITY Each Common Cause $1,000,000 A A108575 01/01/2019 01/01/2020 Aggregate $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) RE: Good Neighbor Days June 6th - 9th Certificate Holder is included as an Additional Insured under the Commercial General Liability and Liquor Liability when required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Hugo Attn: Michele Lindau ACCORDANCE WITH THE POLICY PROVISIONS. 14669 Fitzgerald Ave N AUTHORIZED REPRESENTATIVE Hugo MN 55038 qv,�� @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD