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<br />"'" -..-. .--..-. ------ . ... .._.........'"1 ...._..."_. .,._. _......,.. . ..A...... 1V. t "'Itl'~ ......Vllcr\oIII <br /> <br />r'c:to~'C'.""VI"" <br /> <br />I <br />J <br /> <br />i I <br />,IINSUIUifl$ AFFORDING C:?~.~,~A.~.~.__... \ NAte:ll .___.__-\ <br />INSlJRF.RA spor't~ & Rae. Provide~~_ ) h._.....___._._.n .. <br />IINf.ill~E~e Be:r)::le~...~;.~~.~.~~~.!:.~!.-!_... .m..t_.. ...... ...._. "_"'" <br /> <br />I :::::~: -.---.-.......-.... .... ..... . .. ....t.~=~.=.:.~. ~~.~~ <br /> <br />i INSU;<ER E. i <br /> <br />01" ID SJ OAT~ (IIMIO~/'tVW) <br />OLLIE-10M/ 05/04/07 <br />THIS Ci:RTIFlCATi: IS ISSUED AS A MATTe~ OF INI'OflMATION <br />ONLY AND CONFERS NO RIGHTS UPON THe CERTIFICATi: <br />HOLDER. THIS CERTIFICATE Does NOT AMeND, eXTEND Ofl <br />ilL TER THE COVERAGE AFFORDED 6Y THI: POLICIES BELOW. <br /> <br />II_CORD.. <br /> <br />CERTIFjCA TE OF LiABiliTY INSURANCE <br /> <br />P~ODUCER <br />Hceovc::rn & I!'i;;;her IDa Agency <br />Affiliate o~ North~rn Capital <br />P.O. nox 9)96 <br />~DDeapo~is NN 55440-9396 <br />Phone:952-996-SS18 Fax:9S2-829-0492 <br />INSUREO <br /> <br />Ollie & Company skate Park <br />PeDDY Evenson <br />13835 Aberdeen St. <br />Ham Lake MN 55304 <br /> <br />COVERAGES <br /> <br />'TI-IE: F'O~ICles OP INSURA~CE LISTED BELOW MAV;" I>llo=N ISSUBJ TO "Me; INSURED NA.\'IED ABOVE FO>! THE POLICY PERIOD INDICATED. NOTW;THSTANO:NG <br />fWY RC.OLJI!l(M[NT. TI::RM OR CONDITION OF ANY C:ONI1'w.:f OR OIl'!~R IJOC:\JMENT WlI1-l REsPE(;T TO WHICH T~!5 CER'l1FICATE MAY !:IE 15SlIED O~ <br />w. Y PI;"TNN THE INSlJIlANCE AfFOrlDE:D flT 'TNt I'U.lCIl,:; I 11:Sc.:flI8ED HEI'lEIN IS SUBJECT TO ALL THE TERMS, EXWJS:ONS AND COND:TIO(l:S Of SUC.H <br />r'<)LIClf:>. AvoliLC;Ar~ IIMIIS 5~WN MAY HAVE BEEN REDlICED BY PAID CLAIMS. <br /> <br />h IJI;IJU<;'r//:ll.f; <br /> <br />~ RETENTION $ <br /> <br />: WORKERS COlllPENSATION AND <br />I EMPLOYERS' LIAell.rTY <br />a ANY 1110rllIE10IWAAlNi::rUEXECUTIVE <br />(.'1'1 ICl.:.Iol'M1~MlJi:.tot l:..Xr:LU\)~D1 <br />"r\;'"IIl:'.(;II!1.llll'ttl,,1 <br />~PCCjAJ.. ~~OVISr()NS hCllMi <br />O'I11ER <br /> <br />i <br />I WC-22-04-:16fl676-01 . <br /> <br />i I <br />i i <br />i I <br /> <br />iPc<;'~:~~,w," ~k-\!eYI~~~~" I L1~ITS <br />I IEACHOCClIRRENCE i~l,OOO,OOO. j <br />07/16/06 i 07/18/07! r~~M;SEi(EDL.';::~:;;.r.e.) ~ ~ 300 !OO.~..~_~.~..:~. <br />I ""'I) hxr IAny on. n....O") ~ 5,000 <br />I ..~~I~~?~.~ ~ .~v INJI.lRY .~~ 0 00 , 000.'-- <br />I GEN[RALA'JGREGATE I ~ 2 ,000,000. <br />I 1!'3~~::~~:~:~?~'!:~.~~:~ f .~- ~~~~~. J)O("'-'" <br />, I <br /> <br />I ,~ <br />I <br />---..----..t.--~._...'~.n .,_ .'.u.. .... <br />I <br />:~~?~:'~~'i:;~Y i ~ <br /> <br /> <br />SOIAY INJli;lv .t-------. ..-...... <br />(P,.'! ./.:l';\.:itJ~,l) .. <br />. .. <br />.--.-----... - <br />I <br />I $ <br />_ 1 <br />AjJTO ON.I. Y - F.A AC:CIi:lF.;~1 I ~ <br />_____..__n..._....._........__... .~.. ... <br />OTHER Tr'AN. EA AC.(, I ~ _.___ <br />AUrOONLY. ""1; i $ . <br /> <br />::~ <br />,..'" .. it:~~:: ~-~:~~ ...... ...--",..1 <br />L~Jr~'ynMh:'s I i'in-I' _._...... .. . i <br />10/20/0; : EL. (AC!, ACC:DEf\.,. ;Et;'- 1.00,000. f' <br />i.....-_.", . ......._.____ _______._.~" <br />lZ.c O,Sf:ASE-EAEMPLOY"E ~_~~~~.OO~j' <br />E.L. DISEASE. POI.ICV LIMn 1$ 5000000. _..__._ <br /> <br /> <br />, <br />I <br />I <br />I <br /> <br />--- <br /> <br />L TR IIISM T'tPE OF INSURANCE POLICY NUMBER <br />I GENERAL ~IA!l11.1TY <br />~. ::~MEFlC:AL GEN5RAi.. LiIl2ILITY '6A2GL1029205-01 <br />, CLAIMS MAL1F. [!] OCCUOl <br /> <br />1-..-..-...... ...----, <br />I ~t~;~~~f~~i~~~ZTJU'?~lP~~ I <br /> <br />AU'fOMOBILE LIASI,-rrt I <br />c-- ANY AlJTO i <br />i-- I <br /> <br />A <br /> <br />t:t)M8IN~lJ ~IN(;L!~ LiMI :' <br />I E~ ~tt,<l~nl) <br /> <br />Al.L OWNF.O AjJTOS <br /> <br />>-- SCHEDULED AUTOS <br />,"gf:T) ^,.:TOS <br /> <br />N(IN.OWNeD AJJTOS I <br /> <br />- -.----.........".........,-.-.-- <br />i <br />I <br />I <br />! <br />I <br />I <br /> <br />I <br />i <br /> <br />pgO"ERTY OAMA\JF <br />(I-'or ,JCCIc:iO~:J <br /> <br />GARAGe LIABILITY <br /> <br />:=l ANY AjJTO <br /> <br />~XC~SStUMSRELLA LIAl!ILITY <br />.'.:~.'] Of~('Ut( f CLArMS WVE <br /> <br />I !lACI" OCCvRRENCE <br /> <br />AGG~EGArE <br /> <br />i <br />10/20/06 ! <br />I <br />I <br />! <br /> <br />OESI R1P'TlOI'l OF OPERA'ilONS I LOCATIONS I VEHICLi:S I EXCLUSIONS ADDi:D!lV ENOOR8EME <br />~vent to be hel~ OD 6/16/07 at Centervi~le ~tdoor Park <br /> <br />L <br /> <br />CERTIFICATE HOLOER <br /> <br />CENTERV <br /> <br />CANCELLATiON <br />SHOULD ANt DF TH~ ABOVE 05SCRlBED POLICI~S ee CANCELLED BEFOR~ THE I<XPIRATION <br />CATe THEOlEOF, THE 18SUII'lGINSURER 'IVILl elllDeAVOR TO IllAIL 10 DAI'$ WRfr:-E>l <br />NO'ilCE TO THE CERTII'tCA'T5 ~O~OER NAJlleC TO n<E LEFT. BUT FAP_UI'lE TO DO SO Sl-'AtL <br /> <br />City of Centerv111e <br />~arks Dep~tme~t <br />1880 ~in street <br />Centervil1e MN 55038 <br /> <br />IMPOSE 1'10 OBll/4:ATlON Ol'l LIABILITY OF AfoN KIND UPOl'lll'lO 11'l3UOlE~, ITS AGENTS OR <br /> <br />REPRESEl'(J'Al1VeS, <br />AUTHO~~OI'lEP~SENTATIVE <br /> <br />-......---/ <br />I <br />J <br />@ACORD CORPORATION 19as <br /> <br />G. Re~~olds r1sher <br /> <br />ACORD 25 12D011081 <br /> <br />/1 <br /> <br />Gd W~vt:60 L00G v0 'hEW <br /> <br />G0t0 G98 Gt9 <br /> <br />. ON 3NOHd <br /> <br />3NI~la ~O lI~W~~d : WO~~ <br />