Malt Beverage, Wine & Liquor License – City of Chamberlain, South Dakota

REQUIRED: This insurance coverage is required if you are planning to sell alcoholic beverages at your event or

facilities rental. A minimum of $500,000 liquor liability is required with City of Chamberlain named as additional insured.

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Name of Insurance Company *

Business Phone *

Agent's Name *

First

Last

Policy Number *

Policy Type *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Please obtain the required insurance and attach an original insurance certificate here. *

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