2010-10-06 P & R Agenda Packet - Laserfiche WebLink

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A C40 R D DATE LIABILITY INSURANCE 09/13/2010 i 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 CER7IFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(es) 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 endorsement(s). PRODUCER CONTACT FARIBO INS. INC. NAME GORDIE WIEGNEDE 1404 NW 7TH STREET PHGNNE 507 - 334 -3929 ac NO• EAMIL A FARIBAULT MN 55021 om INSURERS AFFORDING COVERAGE N=it INSURED INSURER A: NAUTILUS INSURANCE COMPANY 17370 FINAL STRETCH INC. PO BOX 121 INSURER 8 12447 150TH ST E 1NSURERC: NERS TRAND MN 55053 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. I LTR TYPE OF INSURANCE POLICY NUMBER M DD EFF M LIMITS NYYYI GENERAL LIABILITY NC 9 7 0 9 2 0 t1 J22/2o 10 01/22/2011 EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY .is Issu ptllBDant t 0 me PREM ISES o ungn e $ 100,000 CLAIMS-MADE n OCCUR to Surplus Lines Insurance kct. The MED EXP Any one son) $ 5 I is an eligible surplus lines in but is not thenvise licensed by The S of PERSONAL a ADV INJURY a 1, o 0 0 , o 0 0 ta. In case of insolvency pa yment GENERAL AGGREGATE s 2 r 0 0 0.0 0 0 GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP/OP AGG s INCLUDED O- POLICY LOC Cl 1S itOt guaranteed. S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea socid" BODILY INJURY (Per person) S ALLOWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS E�� DAMAGE S NON -OWNED AUTOS S S UMBRELLA LIAR I JOCCUR EACH OC CURRENCE $ ±7 FDUCT113I.r. LIAR CLAIMS -MADE AGGREGATE S 10N S $ WORKERS COMPENSATION WCSTATU- OTH- AND EMPLOYERS LIABILITY YIN ANY PROPRIErOR/PARTNERAEKECUTIVE E EACH ACCIDENT s OFFICER/MEMBER EXCLUDED? F NIA (Mandatory In NH) E.L. DISEASE - EA EMPLOY $ If yec desame under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I S DESCRIPTION OF OPERATIONS / LOCATIONS / V8 *CLfS (Attach AOORD 101, AdMonY Remarks Schedula. K mom space Is required) SPECIAL EVENT - IVp DASH - 5K AND 5 MILE RUN DATE OF EVENT: 1113/2010 CERTIFICATE HOLDER - THE GOVERNMENT AGENCY, IT'S OFFICERS, EMPLOYEES AND ASSIGNS ARE LISTED AS ADDITIONAL INSURED CERTIFICATE HOLDER 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. CITY OF CENTERVILLE AUTHORIZED REPRESENTATNE 1880 MAIN STREET deen/kk President CENTERVILLE, MN 55038 ®1988 -2009 ACORD CORPORATION. AM rights) reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD