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MIDWEVE-01 AdOCORE)o I CERTIFICATE OF LIABILITY INSURANCE DATES 12JO712017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERMFICATE HOLDER.TIMS 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 INSUREIRS),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. I P TANTa If the certificate holder Iran ADDITIONAL INSURED,the polls y(les)must have ADDITIONAL INSURED provisions or be endorsed. ON IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A obbernent on does not comer rEPIT& a the certificate holder In lieu of such ondommentisi. I C REPRESENTATIVE H E E -8 I CERTIFICATE P 0 URE W F S T ISE "A A 0 IN A IS IN 1 _Ge PR c I well B T h5t'i T IS T T A End we AS HUR Internet! at Mountain States Limited A I It GoI ff a" C S T 0 If I A MEN C in I IN AMT E ISO I F the u S CERTIFICATE S Aral DATE j_IN A Z� 1 12177 mm LER. D111, rnI 2 E no�ia S 45 Am Avenue,Suite 31 JUDI Paul,IS 5 5 IN 5117-INO NMC 0 --------------- -------------------------------—----------------------------------------------------------------- INS RER A Scothe dam.-ina prence ip ------ an INSURED INSURER 0 ---------------------------------- --—---------- Midwe1 *'at , st Events,DEC INSURER C ------------------------------------- ----------- 1090 Whittaker IN INSURER D White Bear Lake,MN 55110 ------ INSURER E' .x_____________________________________ INSURER F COVERAGES, CERTIFICATE NUMBER- ------ R ION NUMBER, P -THIS IS TO 6ERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A13OVE FOR THE POLICY PERIOD ��T�7 !�!TG M !NDICATE[L NOTNITHSTANDING ANY REQUIREMENT, 'TERM OR CONDITION' OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT 701INHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDMONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .......f.........—----------------- -- ------------------—---------------------------- ------------------------------------ INSR ADIALM-j- IPOLICY Err 1 POLICY EGA -TYPE OF INSURANCE _________t0LJCY AUNBPR WRITE A 1 X COMMERCIAL GENERAL LLWIUTY EACH OCCURRENCE 1,000,000 X W;XUR -D SE E TO RE NT ED CLAIMS-MADE L TC ALAI tPS2763132 12101112017 12MI1201 0 100,00 �vvvvT------------------- 5.000 MED I 1,000,000 ---------------------------- GEOPL AGGREGATE LIMIT :PLIESPER; 2�000,000 GENERAL AGGREGATE r—--------------------------- -- POLICY F PE 2,01)%0*0 ------ LOC PRODUCTS-COMP'OP AGO r—----------------------- ------- OTHFR° ------- ------ ------- AUTQP*DAILS LIABILITY COMISNED SINGLE LIMIT A----------------- ANY AUTO R APP 1E C RE L R, ED SCHERLjLED OWNED ------------------- AUTOS ONLY AU;TOS ED I GO IN RTY ACE A IN T MRS ONLY --- NAITT404rONNJ� C ........................... ............................ - n tJMBRELLA LIAR COX OCCUR .......II.GCOLIDDROC-E. .. S ............................ - ---------------------------- EXCESS LIAR CLAIMSMADE1 i i ------------ WANT ............................... ---------------------------- 13FD RETENTIONS a TIS -a iV#ORKERS COMPENSAnON PER AND EMPLOYERS'LIASIUTY F YIN E i ANY PROPRIDTORIPARTNEIMEXECUTIVE 1 Q MIA -L ID ............................—---------- LU --------------- IIa.Li .RF, .4 ............................... sL.DISEASE-POLICY LIMIT DESCRIP TON OF OIC TIONS 1 LOCATIONS I VENICLEM PCORD 104,Adduanal Rft Sdindula,vVy As Armond K mone Grow is required) CRY Of Centerville Is an Additional Insured with regards fzr(insert Line of Business-General Liability)If required by written contract per form CG20260411. -------- ------------—--------------- CERTIF'I-CATE HOLDER--- CANCELLATION ----------- ........—--—--------- =CAN'C&LED BEFORE USA F TSCAR GELIVS E EROD IN NO. SHOIN P BY 0 ON P: T14E EX [PAT 0 RUMOR GANCE WITH T ...... ..... UTHOU, _F, X N� SENT SHOULD ANY OF THE ABOVIE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL ME DELIVERED IN City of Centerville ACCORDANCE WITH THE POLICY PROVISIONS. 1880 Main St Centerville,MN 55038 -------------- ------ AUTHORIZED REPRESENTATrVE ?z:BoB --------------_L--—---—Wm______ _ __ w w_ ADDING ------- ADDING 25(2016/03) 01988-2015ACORD CORPORATION, All rights reserved. The ACORD name and logo are regitttet*d marks of ACORD 11