2023-05-03 Set Agenda Packet - Laserfiche WebLink

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AC�® DATE (MMMD/YYYYj L CERTIFICATE OF LIABILITY INSURANCE 03129r2023 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: _ Association Member Benefits Advisors, LLC. PHONE 1-800.503-9227 'FAX In CA dba Assn. Member Benefits & Insurance Agency i'00C No. Erne IA,IC_NSYh M&IIIA&31M1 EMAIL PO Box 14575 ADDRESS: plscisteam.serviceammercer.com Des Moines, IA 50306-4575 INSURERl S}�{FFORONC.00w. t?FVJ'E. _ NAIC iI INSURERA: New Ha ;1 hlFe In5Ur8nce CO- _ 23641 INSURED Anoka Co Radio/Emergency Service C10 Robert W. Cardell CEO PO Box 982 Anoka, MN 55303 INSURER B ANMJ89l9�L. 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 DDL aUBR POLICYEFF POLICY EXP LTR TYPEOFINSURANCE POLICY NUMBER MMIDD,+-°= MMlDD'FV11LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS -MADE E OCCUR ElPREMI RGL-724982404 02/01/2023 02/01/2024 . EYORENTED - PREMISES I€a occurrence $100 000 _ MED FXPAn, one Berson. 1 $10 ODD _ PERSONAL & AOV INJURY 91.000 000 GENT AGGREGATE LIMIT APPLIES PER: X POLICY ❑ PRO-❑ LOC OTHER JECT AUTOMOBILE LIABILITY ANYAUTO ❑ O RGL-724982404 OWNED AUTOS ONLY SCHEDULED X HIRED AUTOS X NON -OWNED ONLY AUTOS ONLY UMBRELLA UAB ' EXCi<SSLU18 DEO RETENTION.$ WORMERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANYPROPRIETORIPARTNEWEXEGUTI VE OFFICLRWLmaFR EXCLUDED? ❑ N/A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below EITHER I I COMBINED SINGLE LIMIT $1,000,000 02/01/2023 02/01/2024 BODILY INJURY (Perperson) $ BODILY INJURY {Per accident) $ PROPERTY DAMAGE $ EACH OCCURRENCE $ IAGGREGATE $ E.L. E.L. PER L i I II DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101,Additional Remarks Schedule, may be attached if more space is required) Effective 06123/2023 include City of Centerville as additional insured: Certificate Holder (CG2011) but only with respects to the named insured's negligence with regards to the ARRL 2023 Field Day event to be held at Laurie Lamotte Park, 6970 Lamotte Dr, Centerville, MN 55038 on 06/23/2023 through 0612512023. CERTIFICATE HOLDER City of Centerville 1880 Main St :enterville, 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 REE PP RRESENTAT IVE ACORD 25 (201 The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved.