11.02 - Temporary Liquor License for Mayson's Grille

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Ite: 6/29/2010 Time: 1:24 PM To: @ 12185685860 Page: 001 -002 MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH ACORA CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYI) AD INSWN 06/29/2010 PRODUCER 952.893.9218 FAX 952.893. 9402 DATE M MIDD THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION CORPORATE 4 INS AGENCY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE GENERAL LIABILITY 6001100552 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR I METRO BOULEVARD EACH OCCURRENCE ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. MN 55439 -2133 X COMMERCIAL GENERAL LIABILITY Laura Erickson INSURERS AFFORDING COVERAGE NAIC # INSURED Mayson's Grille, LLC INSURER A: West Bend Mutual 15350 DBA : Mayson' s Grille INSURER B $ 10,00( P.O. BOX 89 INSURER C: 31020 Government Drive INSURER $ 1,000,00( Pequot Lakes, MN 56472 INSURER COVFROGFS 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR AD INSWN TYPE OF INSURANCE POLICY NUMBER DATE M MIDD POLICY EXPIRATION DATE MIDD LIMITS GENERAL LIABILITY 6001100552 07/01/2010 06/30/2011 EACH OCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ 200,00( CLAIMS MADE F-�-] OCCUR MED EXP (Arty one person) $ 10,00( A PERSONAL & ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP /OP AGG $ 3,000,000 POLICY JE 0. LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMB (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY. AGG EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F-1 CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE F-1 OFFICERIMEMBER EXCLUDED? TORY LIMITS ER E.L. EACH ACCIDENT $ E L DISEASE - EA EMPLOYEE $ (Mandatory in NH) Kyes, describe under E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below A OTHER Liquor Liability CP01100637 07/01/2010 06/30/2011 $1,000,000. per occ/ $2,000,000. agg DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS City of Pequot Lakes is Additional Insured as respects special event to be held on: - 27 -10, MS Tram Charity Bike Run, 12:00 pm to 11:00 pm General Liability & Liquor Liability coverage extends to service /street area on Government Drive GtK I RIGA I t MULUtK GANGELLATION City of Pequot Lakes Attn: Sandy Peine 4638 County Road 11 Pequot Lakes, MN 56472 (2009/01) FAX: 218.568.5860 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Dan Lindsay /LAURAE ACORD CORPORATION. All The ACORD name and logo are registered marks of ACORD