2021-04-14 CC Packet - Laserfiche WebLink

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DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/31/2021 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). CONTACT PRODUCER NAME: Mercer Consumer, a service of PHONE FAX 1-800-503-9227 (A/C, No, Ext): (A/C, No): 515-365-3005 Mercer Health & Benefits Administration LLC EMAIL plsdsteam.service@mercer.com PO Box 14575 ADDRESS: Des Moines, IA 50306-4575 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : New Hampshire Insurance Co. 23841 INSURED INSURER B : Anoka Co Radio/Emergency Service INSURER C : C/O Robert W. Cardell CEO INSURER D : PO Box 982 INSURER E : Anoka, MN 55303 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 POLICY EFF ADDL SUBR POLICY EXP TYPE OF INSURANCE LIMITS POLICY NUMBER (MM/DD/YYYY) LTR (MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY A x EACH OCCURRENCE $1,000,000 X DAMAGE TO RENTED CLAIMS-MADE X OCCUR 02/01/2021 02/01/2022 RGL-724982402 PREMISES (Ea occurrence) $100,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- x PRODUCTS - COMP/OP AGG $1,000,000 LOC JECT OTHER: $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $1,000,000 (Eaaccident) X ANY AUTO BODILY INJURY (Per person) $ RGL-724982402 02/01/2021 02/01/2022 OWNED BODILY INJURY (Per accident) $ SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED AUTOS $ x x NON-OWNED (Peraccident) ONLY AUTOS ONLY $ UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ $ DED RETENTION $ PER OTH- WORKERS COMPENSATION STATUTE ER AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under 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 06/25/2021 include City of Centerville as additional insured: Certificate Holder (CG2011) but only with respects to the named insuredÓs negligence with regards to the Field Day event to be held at Laurie Lamotte Park 6970 Lamotte Drive Centerville MN 55038 on 06/25/2021 through 06/27/2021. CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Centerville THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1880 Main St ACCORDANCE WITH THE POLICY PROVISIONS. Centerville MN 55038 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD