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A`coR& CERTIFICATE <br /> OF LIABILITY INSURANCE DATEoffmo^rym <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS <br /> 7/15/2014 <br /> CERTIFICATE DOES NOT AFF F INSURANCE <br /> OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <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: If the certificate holder Is an ADDITIONAL INSURED,the poll:Y(Ie8)must be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain Policies may certificate holder in lieu of such endomemengs), y requflB an endoraemelll A statement on this certificate does not confer rights to the <br /> PROLxrcER <br /> BW Insurance Agency, Inc. N Carol Tveit <br /> 245 E Roselawn Ave E (651)d88-0789 FAX <br /> .(651)188-0989 <br /> $t. Paul MN 55117-1940 MISURE S AFFORDINGCOVERAGE NAK M <br /> INSURED (�' �� B+SURERA West Bend Mutual Insurance <br /> cial Events VI <br /> TRI FITNESS LLC 1 INSURERS: 5350 <br /> 1338 HIGHWAY 96 E 'lQ1�I sISURER C: <br /> INSURER D, <br /> WHITE BEAR LAM MN 55110 INSURER E: <br /> COVERAGES CERTIFICATENUMBER:2014 �,/ INSURERF: <br /> THIS IS TO CERTIFY THAT THE POLfCIES OF INS URANCE LISTED BELOW HAVE BEEN ISS D TO THE SUREDARREVIS7EOD ANUMBEUR THE POLICY PERIOD <br /> INDICATED. NOTAITHSTANDING 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 DESCRIBED HEREI"1 IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND COP'OITIO":S OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WHICH THIS <br /> INBR <br /> TYPE OF INSURANCE POLICY EFF POLICY <br /> GENERAL.LIABILITY POLICY N MBEXP ER LAM <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> A CLAIMS-MADE Ez OCCUR SM150532 /14/2014 /14/2015 PR I Ea $ 200,000 <br /> MED EXP(An one person) $ 10,000 <br /> PERSONAL BADV INJURY $ 1,000,000 <br /> GEWL AGGREGATE LIMIT APPLIES PER: GENE RALAGGREGATE $ 3,000,000 <br /> X POLICY PRO. LOC PRODUCTS-COMPIOPAGG S 3,000,000 <br /> AUTOMOBILE LIABILITY $ <br /> ANY AUTO <br /> cBIddsnll IN L LI T <br /> ALL OWNEDSCHEDULED BODILY INJURY(Per person) S <br /> AUTOS OS <br /> HIRED AUTOS WN MED BODILY INJURY(Per acciEeno S <br /> AUTOS PR Per RT DAM E <br /> r A <br /> s <br /> UMBRELLA UAB OCCUR $ <br /> EXCESS LIAR CLAIM EACH OCCURRENCE $ <br /> DED R NT AGGREGATE S <br /> WORKERS COMPENSATION <br /> AND EMPLOYERS'LIABRJTY $ <br /> S AO H <br /> ANY PROPRIETORIPARTNERIEXECUTIVE YIN TU <br /> OFFICERIMEMSER EXCLUDED? ❑ NIA E.L.EACH ACCIDENT <br /> pMndatay In NH) $ <br /> DEtf <br /> SCRIPTION OF OPERATIONS be,.. E L DISEASE-EA EMPLOYEE $ <br /> E.L.DISEASE-POLICY LIMIT S <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,pdditiond R�,w Sc y�space M��Ired) <br /> RE: My First Tri Race on August 23, 2014. <br /> CERTIFICATE HOLDER <br /> CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> City of Centerville ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 1880 Main St <br /> Centerville, MN 55038 AUTHORIZED REPRESENTATIVE <br /> chael Wilman/STPCT <br /> ACORD 25(2010/05) <br /> IN3025nntmtlm Tho Ar`npn narno onto Innn aro 1 nanle'"FA narks f AtInan010 ORD CORPORATION. All rights reserved. <br /> - _ -- - - -- P37 <br />