2013-12-11 CC Packet - Laserfiche WebLink

Home Browse Search

Dec 06 13 09:53a p ,2 VACAT -1 OP 1D: TL CERTIFICATE OF LIABILITY INSURANCE o 12105120 3 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 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). CONTACT PRODUCER NAA1E)_ Tara L Faribo Insurance Agency Inc. - PHONE - - —� -- FAX 1404 NW 7th Street (mac, vo,� X73343 _ _ (tAic, H ,t: 50 7-332 - 8 _ Faribault, MN 55021 aOOgEss: tara@fa riboins.CDm _ Tara Langevin — —,_ INSURERI AL FFOR DMG COVERAGE -. _ NAIC q -- _ INSURER A Natio Spe cialty Insuran INSURED V8Cat10n S p - 0 rt3 l nc — IN SURERS: d ba Front Runner INSURER C 1565 9th Street White Bear Lake, MN 55110 INSURER D: NiSUR E : - INSURER CERTIFICATE NUMBER: REVISION NUMBER: TI•'IS IS TO CERTIFY THAT THE PCLICIES OF INSURANCE LISTED BELOJJ HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE POR THE aOLIC'Y PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CON017ION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH - HIS CERTIFICATE MAY BE ISSLED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND C OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS ____ __ _ ___ - - ----------------- - --- -- ADD UeR ^- •--- POLICY EFf POLICY EKP r IL S R R I� TYPE OF INSURANCE POLICY NUMBER '• Nd)OrYYYY MMlDOiYYYY I LIMITS j GENERAL LIABILITY I i I EACH OCCURPENCE is 1,000,DOO X ; CCreMcRCIAL GENER LIABILIT' X 0111034712 ! 10121120131 1012112014 1 PREMISES Ea ocwirence _S 100,00 CLAPAS -\LADE X_ OCCUR ; I 1 MED EXP (Anyone person: $ _- _ 2,5 I PERSONAL S ADV INJURY 1 3 1,000,00 h --• --- - - -- i i i I GENEP.A AGGREGAT 5 3,000,00 GEN 'dR 'L AGGRE LI APPJES PER ro ' • PR ODUCTS • COMP A.GG µ 3 ,000 ,00 RO• I POLICY I P LOC I � ._ S AUTOMOBILE LIABILITI' I COMBINED SINGLE LIMIT � UT _ - -- - A _ ( lEaaco�nl) S ANY ALIT^ 1 1 i B IN ( ;'a, person) is 1 -- A NYAUT ED I SCMEDLLED kk _- T--- ___ - - - - - ' AUTOS I BODILY INJURY [Per ao;ijenq i S AUTC•S A �- NON- DVYNED ! I PPD ERTY DAMAGE £ — -- ! 1 HIREC AUTOS AUTDS i i PER ACC DE NT, � -- " - - --� �(' UMBRELLA LIAB 1 X i OCCUR j EACH OCCURRENCE 1 5 i — E><cES uqe _ C� IMS tdAD_ E_I X 0111034712 10/2112013 tO/2112D14 (AGGRE - _ - - _t 5 — 1,DQ0,00 DED RETENTIONS $ WCRKERS COMPENSATION *C STATU• 0TH - AND EMPLOYERS' LIABILITY VIN I E L EACP LIIdIDS._— !.,ER-� EACH ACCIDENT ' i.RY 0ROFRIETORRARTNEPIEXFCUTfvS �- " "� i - - -- I NI0.I OFFICERrMEVBER EXCLUDED i I (Mo.darcy in NHl + EL O.SE ASE -EA EMPLOYEE i _ .� yes. eescnbe under 1 LIMIT - -' DESCRIPTION OF OFERAYIDNS bHow { ! El DISEASE LIMIT I S 1 DESCRIPTION OF OPERATIONS, LOCATIONS /VEHICLES (Anaoh ACORO 151, Additional Rrmarks schoduls, N more space a required) This certificate or memorandum of insurance does not affirmatively or negatively amend,eztend,or alter the coverage afforded by the insurance P olley City Cf Centerville, ic's employees, volunteers and as assigns, named as additional insured- automatice status when required by written contract with you (07$1890)4/08) CERTIFICATE HOLDER CANCELLATION FR -6 -02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Centerville Shake Your Shamrock AUTHORRED REPRESENTATIVE 1880 Main St Tara Langev Centerville, MN 55038 ©1988.2010 ACORD CORPORA,,10N. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 18