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ACC>R b® CERTIFICATE <br /> OF LIABILITY INSURANCE DATE(M <br /> THIS CERTIFICATE IS SUEQ AS A MATTER OF INFO7/15/2014 <br /> CERTIFICATE DOES NOT AFFIRMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOL ER. THIS <br /> MATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE pOtiCifS <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER <br /> IMPORTANT: c the conditions of certificate holder hs an ADDITIONAL INS11 URED <br /> the teens and c ,the pollcyI l 8)must be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the policy,certain policies ma <br /> F,8 <br /> lder in lieu of such endorseme y require an endorsement A statement on this certificate does not confer rtghts to the <br /> s)• <br /> ce en ZFWE <br /> CONc Carol Tveit <br /> J �'y, Inc. <br /> vn Ave (651)488-0789 F (651)488-0989 <br /> MN 55117-1940M►suRE s AFFORDINOCOVERAGE <br /> INSURED 1 y, INSURERA West Send Mutual InsuranceNAICx <br /> 53 <br /> TRI FITNESS LLC a-. •+" slsuRERe: <br /> 50 <br /> 1339 HIGHWAY 96 E `lQ�� INSURERc: <br /> INSURER D: <br /> WHITE BEAR LAKE MN 55110 INSURER E: <br /> COVERAGES CERTIFICATE NUMBER:2014 GL/SpLUMIU <br /> ecial FEvents <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREOAR1EOp A6UMBEUR THE POLICY PERIOD <br /> INDICATED. NOT4i9TFiSTANDIt:^v ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIB E'D HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND COVO!TIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WHICH THIS <br /> INBR <br /> TYPE OF INSURANCE POLICY EFF POLICY <br /> (ENS , N R LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> A CLAIMS-MADE OCCUR SN2150532 PR MI a S 200,000 <br /> /14/2014 /14/2015 MED EXP(Any one reon) $ 10,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 <br /> X POLICY PRO- LOC PRODUCTS-COMP/OPAGG $ 3,000,000 <br /> AUTOMOBILE LIABILITY $ <br /> ANY AUTO <br /> BI tSIN L LI <br /> AALUL O SC <br /> ED HEDULED BODILY INJURY(Per person) i <br /> AUTOS BODILY INJURY(Per accident) s <br /> HIREDAUTOS N�OWNED <br /> AUTOS RP��IDPer = <br /> UMBRELLA LUAB OCCUR = <br /> EXCESS LaAB CLAIMS-MADE EACH OCCURRENCE _ <br /> DED R NTI AGGREGATE _ <br /> WORKERS COMPENSATION <br /> AND EMPLOYERS,LIABILITY =OPRI S ATI- H <br /> OFFI PCERIMEMBER EXCLUDED? <br /> a N/A <br /> as ' Under <br /> In NH) E.L.EACH ACCIDENT $ - <br /> DESCRI OFA OPERATIONS below E.L.DISEASE-EA EMPLOYE $ <br /> E.L.DISEASE-POUCY LIMIT a <br /> DESCRIPTM OF OPERATIONS/LOCATIONS 1 VEHICLES(Attach ACORD 181,Aditoml Remarks ScheduK K MOM space Is required) <br /> RE: My First Tri Race on August 23, 2014. <br /> CERTIFICATE HOLDER <br /> CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 71880Y <br /> f Centerville ACCORDANCE WITH THE POLICY PROVISIONS <br /> ain St <br /> Centerville, MN 55038 AUTHORIZED REPRESENTATIVE <br /> chael Wilman/STPCT <br /> ACORD 25(2010/05) <br /> iN302s rxl,rnttm Tho Af:nQr1 name anti Inn^aro ronier+arad marks ovF2ArnRnORD CORPORATION. All rights reserved. <br />