2021-08-25 CC Packet - Laserfiche WebLink

Home Browse Search

ACO " CERTIFICATE OF LIABILITY INSURANCE �ATE`MM,DD"ryYY' L 8/20/2021 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(les) must be endorsed. If SUBROGATION IS WANED, 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 endorsements'".. PRODUCER Nest Bend Mutual Insurance Company 1900 South 18th Avenue Nest Bend NI 53095 INSURED Centerville Lions Club 7155 Braun Dr Centerville MN 55038-8729 CONTACT Rep _ NAME: PHONE (866)926-4244 FAX {252)365-2200 10",-, Ma. Es1L _ _ IAIC, No;: L ADDRE� Customercare@wbmi . com DDR INSURERJS1AFFORDING COVERAGE NA INSURERA-West Bend Mutual Insurance Company 1535 INSURER B : INSURER C : INSURER D : INSURER E : ,+L^oTIL^IrwtC �11 I&Mn=n.P•T.17 r.'2 n 0 d A. 17 DC111 CIl]A1 IN1 111A RKID V V•I..I 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 I 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. _ IhT41i TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP `::•� . POLICY NUMBER 7 _ ti'S rYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $ 1,000,000 Eoccurrence: NTED $ 100, 000 A CLAIMS -MADE OCCUR PREMISES SES ;Ea _ _ A175402 7/7/2017 7/7/2018 MEDEXP(Anyone person) $ PERSONAL &ADVINJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: ' GENERAL AGGREGATE $ 2,000,000 ❑ PRO-JEGT ❑ LOC X POLICY PRODUCTS -COMPIOPAGG $ 2,DOO,000 CITHER COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY �Ea acddentl I ANY AUTO BODILY INJURY {Per person) $ ALL OWNED I SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED I -- PROPERTY DAMAGE $ HIRED AUTOS AUTOS ..IPer a — — UMBRELLA LIAB I OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE; AGGREGATE $ I QED TENTION '$ WORKERS COMPENSATION P R ANDEMPLOYERS'LIABILITY YIN — —€� — ANYPROPRIETORIPARTNEWEXECUTIVE E.L. EACH ACCIDENT $ _ _ OFFICRIMEMBER EXCLUDED? N 1 A ❑ (Mandatory in NH) E.L. DISEASE - EA EMPLOYE". $ If yes, destaibe under DESCRIPTION F OPERATIONS below E-L. DISEASE -POLICY LIMIT $ A LIQUOR LIABILITY A175406 7/7/2017 7/7/2018 AGGREGATE 1,000,000 EACH COMMON CAUSE 1,000,000 pE$CRIFnON OF OPERATIONS I L CATIONS ! YEHICLES iACDI4D 101. Atld o al Remarks Schedule n a!! attachetl R Is uind City of Centerville is listed as Additional Insured under the General Liability per form NS0280 Chili Cook -Off Contest Church of St Genevieve is listed as Additional Insured under the General Liability per form NS0280 October 2, 2021 Chili Cook Off Contest St. Genevieve's Education Bldg. Parking Lot at 6995 Centerville Road (1664 Heritage), Hugo, M 55038 CERTIFICATE HOLDER City of Centerville 1880 Drain St Centerville, MN 55038 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. AUTHORIZED REPRESENTATIVE P Kolimansberger/PKOL C aa4� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (20140t)