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A� ©6 CERTIFICATE OF LIABILITY INSURANCE DATE /DD/YYYY) 3/23rz3nozz 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 RDM Insurance Agency, Inc. 9201 Lexington Ave N Circle Pines MN 55014 CUNTAVT NAME: Macey Cannon PHONE 763 7$4-2426 763-784-2499 A/C, No, Ext : (A/C, No): ADDRESS: macey@rdmagency.Com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Liberty Mutual Insurance 23035 INSURED Independent School Dist #12 4707 North Road Circle Pines MN 55014 INSURER B : INSURER C : INSURER D : INSURER E : 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A x' COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F) c_] OCCUR. YU2-Z51-293425-041 07/01/2021 07/01/2022 EACH OCCURRENCE $ 1,000,000 PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PE � M LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO /� y AUTOS ONLY OWNED v AUTOS SCHEDULED ' /� y HIRED v NON -OWNED AUTOS ONLY /► AUTOS ONLY AS5-Z51-293425-011 07/01/2021 07/01/2022 (Ea accident) IMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per accident) $ A UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE TH7-Z51-293425-051 07/01/2021 07/01/2022 EACH OCCURRENCE $ 5,000,000 x AGGREGATE $ 5,000,000 DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N ANY PROPRIETOR/PARTNER/EXECUTIVE El OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N 1 A STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A School Leaders E & O CU 8475814 07/01/2021 07/01/2022 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Centerville ACCORDANCE WITH THE POLICY PROVISIONS. 1880 Main Street I AUTHORIZED REPRESENTATIVE Centerville MN 55038 U 1988-2015 ACORD CURPORATIUN. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD