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,�co CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 1 2/26/2013 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. MPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 A NAME: Associated Insurance Agents, Inc. (AIA) PHONE FAX — 2800 Freeway Boulevard E C, No •7 - 4 -2 a/c N. MAIL Brooklyn Center MN 55430 ADDRESS. m INSURERS AFFORDING COVERAGE NAIC # INSURER A :SeleCtiVe Insurance Co INSURED don use this one INSURERB: Goetz Landscape &Irrigation Inc INSURER C: Joe Goetz 2030 Main St INSURERD: Centerville MN 55038 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 857390336 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MM /DDIYYYY ) (MM/DD/YYYYI LIMITS A GENERAL LIABILITY Y 52024833 /1/2012 /1/2013 EACH OCCURRENCE $1,000,000 X DAMAGE TO RENTED -- COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $100,000 CLAIMS -MADE KI OCCUR MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $3,000,000 _ POLICY J CT LOC $ - cm D SINGLE DWT A AUTOMOBILE LIABILITY $2024833 /1/2012 /1/2013 Ea accdent _ $1,000,0 X� ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED PROPERTY DAMAGE Ix HIRED AUTOS X AUTOS Per accident $ $ A X UMBRELLA LIAB X OCCUR 52024833 /112012 /1/2013 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $1,000,000 DED X RETENTION$0 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N IT -R ANY PROPRIETOR /PARTNER /EXECUTIVE E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? F NIA — -- (Mandatory In NH) E L DISEASE - EA EMPLOYEE $ If yes, descnbe under DESCRIPTION OF OPERATIONS below E L DISEASE -POLICY LIMIT $ :1-, _T i DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is Additional Insured on the General Liability policy when required by written contract with the Named Insured Policy also Includes a Waiver of Subrogation clause 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 Centerville ACCORDANCE WITH THE POLICY PROVISIONS. 1880 Main Street Centerville MN 55038 AUTHORIZED REPRESENTATIVE ' ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 27