2019-04-24 CC Packet - Laserfiche WebLink

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DATE CERTIFICATE OF LIABILITY INSURANCE (MM/DD/YYYY) 1 04/11/2019 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 have ADDITIONAL INSURED provisions or 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 NAME: Mercer Consumer,a service of PHONE 1-800-503-9230 FAX Mercer Health&Benefits Administration LLC A/C No Ext: 515-365-3005 PO Box 14575 EMAIL ADDRESS: p s c Isdsteamervice mercecom Des Moines,IA 50306-4575 INSURERS AFFORDING COVERAGE NAIC# INSURERA:New Hampshire Insurance Co. 23841 INSURED INSURER B Anoka Cc Radio/Emergency Service INSURERC: C/O Robert W.Cardell CEO PO Box 982 INSURERD: Anoka,MN 55303 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 TYPEOF INSURANCE ADDL SUBR LTR POLICY NUMBER MM DD/YYYY D MM/ YYYY LIMITS COMMERCIAL GENERAL LIABILITY A X EACH OCCURRENCE $1,000,000 CLAIMS-MADE �X DA OCCUR RGL-724982400 02/01/2019 02/01/2020 PREMISEsO(Ea oecurrDence $100,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $1,000,000 OTHER: AUTOMOBILE LIABILITY ❑ ❑ COMBINED SINGLE LIMIT $1,000,000 ANY AUTO RGL-724982400 02/01/2019 02/01/2020 BODILY INJURY(Per person) $ OWNED BODILY INJURY(Per accident) $ AUTOS ONLY SCHEDULED HIRED AUTOS AUTOS PROPERTY DAMAGE X ONLY P NON-OWNED $ AUTOS ONLY $ UMBRELLA LAB EACH OCCURRENCE $ EXCESSLIAB H AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER LITE OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $ (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Effective 06/21/2019 include City of Centerville as additional insured: Certificate Holder(CG2011)but only with respects to the named insured's negligence with regards to the Anoka County Radio Club/ARRL Field Day event to be held at Laurie Lamomotte Park,6970 Lammotte Drive, Centerville MN 55038 on 06/21/2019 through 06/23/2019. CERTIFICATE HOLDER CANCELLATION City of Centerville SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1880 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Centerville, MN 55038 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Ao'kC ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered m11pof ACORD