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HomeMy WebLinkAboutContract 1723· DATE (MM/DD/YYYY) ACORO CERTIFICATE OF LIABILITY PROO-b-0~'E (9-'~-~93--~ ~ ~)~9~ ~~SUED AS A~OF INFORMATION ONLY AND CONFERS NO RIGHTS UPO HE CERTIFICATE COR~RATE 4 INS AGENCY, ~NC. HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR 7220 NETRO BOULEVARD ALTER THE COVE~GE AFFORDED BY THE POLICIES BELOW. ED~NA, MN 55439-2133 INSURERS AFFORDING COVE~GE NAIC ,.SU,E~ Colu~ia Heights l~ons Club INSURERA: Lexington ~~cn ~ Box 21183 INSURERS: Co]u~ia Heights, MN S5420 INSURERC: INSURER E: COVERAGES ~'~:~'~ ~ PLe~I~;*;~TEI~i NOTWITHSTANDIN THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PLe~IC';~I~I~i NOTWITHSTANDIN 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. POLICY EFFECTIVE POLICY EXPIRATION INSRLTR NEp~DDI TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DDfYY) LIMITS GENERAL LIABILITY .... EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES (Es occurence) I CLAIMS MADE II OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/Dp AGG $ IPOLICY[~ PRO' JECT [~] LOC AUTOMOBILE LIABILITY THIS INSURANCE IS I~;;ul=u r'unou~ ,-, , ~, ANY AUTO THE MINNESOTA SURPLI JS LINES INSU =J~NCE (EaCOMBINEDaccident)SINGLE LIMIT $ ALL OWNED AUTOS ACT. THE INSURER IS A q ELIGIBLE SI RPLUS SCHEDULED AUTOS LINES'INSURER BUT S NOT OTHE ~WlSEiTA. IN {ParBODILYINJURYperson) $ H~RED AUTOS LICENSED BY THE STAq E OF MINNES CASE OF INSOLVENCY, PAYMENT OF :I.AIMS BODILY INJURY $ .ON-OWNED ^UTOS IS NOT GUARANTEED. (Per accident) PROPERTY DAMAGE LINES TAX -- (Per accident) gU.RPLUS GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ I ANYAUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ IOCCUR ~ CLAIMS MADE AGGREGATE $ $ I DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND I TORY LIMITS I D I H- ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE~ $ Ifyes, deSCribe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT OTHER 9911169 01/01/2003 01/01/2004 See Below Liquor Liabi] 'ity A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHI~ :LES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS _im~ts: $10,000 PD each occurrence/$300,O00 BI each person and each occurrence/ I;300,000 loss of support each person and each occurrence/$600,O00 aggregate limit per club. :~ty of Columbia Heights is additional insured with respect to Columbia Heights Lions Club )articipation in 3amboree Celebration, 3une 24-30, 2003 and their use of facilities at Murzyn CERTIFICATE HOLDER City of Columbia Heights ATTN: Sue Schmidtbauer S90 40th Ave. NE Columbia Heights, MN S$421 ACORD 25 (2001108) FAX: (763)706-3671 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZE D REPRESENTATIVE ~,.~['--'~ ~ ~. ,~ ~ Dan Li ndsa),/MB ~ ©ACORD CORPORATION 1988 FAX ~0. CITY OF COLUMBIA HEIGHTS JOHN P. MURZYN HALL CONTRACT FOR SERVICES ,, IT IS HE,,~,, BY AGREED THAT COLUMBI~ HEIGHTS LIONS CLUB. (h~eh~f~er rcfer~' to as CONTRACTOR ) will furnish services as herei/tr/stated for the CITY OF COLUMBIA HEIGHTS (h~minaf~r rcfcr~d to as "CITY"). // This agr~ment shall take effect upon its ~e~ution by both parties and shall mm.aha in effect m~til December 31, ~Z00$ at which time it shall be automatically terminated. This agreement is subjec-~ to temptation by the CITY upon 30 days xmtten notice. LIOUDR _SERVICES TO BE PE.RFORMED UNDER TERMS OF THIS AGREEMENT Provid~ dram shop and liability insamnc~ with the City of Columbia Heights listed as a~itional Msu~ aM in ~ounts appmv~ by thc Ciw. ~e Recreation D~ar~ent must be provided with a ~fftm~ of im~m prior to provi~ag ~y liquor ~i~ heremder. Provide bar ~d liquor s~i~ by ~ain~ and compe~t There mint bo no alcohol mmqum~d w~l~ pmvid~g s,~ims hcmtmder. Liqu~ is m be sem~ at mqu~qt~ sma th~ and b~ close mint be at 12:30 ~ght unl~s mqu~ mrli~. B~endom mtmt clean bar and su~dmg ar~ a~ each and ~c~ evmt to ~c satisfaction of the City. U~is is m include helping ,amtaker mp~ flash conainers in ~e bar arm. Bar is to bc le~ in the same condition as it was fo~d. No Lion's members are to p~nt at ~ b~ unless wo~ng tho ~mt or attending flxe event. Not wi~tanding an~hing to tho conm~ h~in, scmc~ ~11 be provided in acmrdanm ruth all s~te ~d fed~ai laws. AGREED THIS 22"" day of April, 2002. It is agreed that said services am to bo rendered as an indel~ndent contractor and not as an employ~ of thc CITY. Thc CONTRACTOR understands lhat the performance of ssrvie~e~ ~ h~r~in stat~l rosy involve some risk of injury or illness to the CONTRACTOR, The CITY will not b~ rospomible for any injury or illm~s <ltemt by the CONTRACTOR, It~e CONTRACTOR'S employees, the CONTRACTOR'S agents during tho time the CONTtLACTOR performs the s~rviem he~oin stated. Furthermor,, th, CONTRACTOR agr~s to defend, indon'afify and hold the CITY harmless from any claims, setions or oth~r precedings which may bt brought against the CITY, flick agents or employees arising from tile CONTRACTOR'S performance of the services as herein stated.