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AC R DATE(MMID �.._ CERTIFICATE OF LIABILITY INSURANCEp.gt3 1 of 1 11/26/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS :ERTIFICATE 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(les)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 CONTACT Willis of Minnesota, Inc, NAME c!o 26 Century Bivd. PHONE Bax 305191 ,Ann EC4- cartificates�rrillis.com Nashville, TN TN 37130-5141 �- _ _ _____ _ _ INSURER(S;AFFOROINGC.OVEr_W_GE -_ - --NAIC t! INSURED - --- - -—_ ___Y (INSURERA American Guarantee and Liability Insuranc}26247-001A Fahrner Asphalt Sealers, LLC INSURER American Zurich Insurance Company 40142-001 6615 us Highway 12 hest INSURER Eau Claire, WI 54702 -- --- ---- --- INSURER D - . INSURER E• -- COVERAGES CERTIFICATE NUMBER:22385540 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 --- iAODI;SUe" --- POLICY EFF POLICY EXP - —�- — ---- LTR TYPE OF INSURANCE POLICY NUMBER LIMITS A X - COMMERCIAL GENERALLIABILTY GLO 5944711-06 12/1/2014 '12/1/2015 .EACH OCCURRENCE _ $ 1,004,.000 _ CLAIMS-MADE X OCCUR _� A E�ENTF�ce_ I$ 300 000 X Contractual Liability MCO EXPIAnY-epersan) `y$ — 51 000- - ;PERSONALSADVWJURY_ ,$ GEN lAGGREGATE,IN��.TOAPPLIESPER '—GENERALAGGR000 ECATE__ _•$ .2000; _ POLICY X JEC- IAC `PRODUCTS•COMP!OP AGG $ 2, -o90,OOO _ OTHER. � S AUTOMOBILE LIABILITY •BAP 5944710-06 12/1/2014 :12/1/2015 WMxNenOtSINGLE LIMIT $ 2,000,000 X ALLOWNED SCHEDULED X A •BODILY INJURY(Perperscn) $ _--- LOWNE - -- - - ---> _. AUTOS AUTOS ;BODILYINJURYtPeracodent) $ X HIREDAUTOS X NON-OWNED •PR0 1Vi�iaAGE. ,AUTOS (PeracaiderK) $ A X UMBRELLALIAB X cxcuR AUC 9377611-11 12/1/2014 12/1/2015'EACHOCCURRENCE ($ 51000 -goo- DED -- - - -'-- EXCE35 LIAR C1AIM5-MADE AG_GREG_A_TE S, 5,000,0100 i}ED REIENTYON$ $ $ WORKERS COMPENSATION A ANDEMPLOYERS'LIABLITY IWC 5944712-06 12/1/2014 12/1/2015 X Y t N •- -S.LAIUIE FR--,_ _ B ANY PROPRICTCRiPARTNEWEXECUTIVE WC 5944713-06 ,12/1/2014 12/1/2015 E_.EACH ACCIDENT �$ 1,000,000 _ OFFICERrMEMSER EXCLUDFD-) N NIA' --, -- - --- - YAandatorybH) _.E.L DISEASE-. FA EMPLOYEE $__ 11000,000 _ yes,describedescribeeun _ ___... DESCRtPT%ONOFOPERATIONS hetow E.L DISEASE-POLICYLIMI- $ 1,000,000 DESCRIPTION OF OPERATIONS f LOCATIONS!VEHICLES(ACORD 101,Add@onai Remarks Schedule.may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Evidence of Coverage AUTHORIZED REPRESENTATIVE Calls 4572040 Tpl:1889674 Cert: 2 85540 01988- 014ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 29