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A. 63 iR DATE (MIAWNYyyi THIS CERTIFICATE IS tSSUED AS A I14ATTER OF 114F'ORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRIVATI'VELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE D•OLS NOT CONSTITUTE A CONTRACT" 'BETWEEN THE ISSUING INSURER(SI, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is Sn ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, suLrject to the terms and conditions of the policy, curtain 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: - ..w.�... G AME-- C'i FARIBO INS. INC. + � NaME GQRDIE WIEGNEbE 1404 NW 7TH STREET 1 MICNo.EX11, 507 - 334 -3929 �r E-MAIL aDDRFSS: FARI13AUDT MN '55021 PRODUCER CWSTOMFR 86 AYt INSURED FINAL STRETCH INC. PCB BOX 121 12447 150TI1 ST E NERSTRAND MN 55053 INSURER($) AFFORDING COVERAGE _ !NAIC 9 INSWRERA.NAUTILUS INSURANCE COMPANY 17370 INSURER B: INSURER C INSURER 0; 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 PERnD 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 ALUC'L UaR POLICY EFF POLICY EXP LTR 'TYPE OF INSURANCE wsR Y1rVD POLICY NUMBER 1MWDO1YYYY1 (MMIOOJYY P LIMITS GENERALLIaBILFTY NC970R20 p1)22/2010 ©112212011 EACHOCCWRRENCE S1,000,000 A X COMMERCIAL GENERAL LIABILITY ;1is I T.Surance 1s issued pursuant to a MA TO RENTED N. itnnesota Surp Li I Axt. The I PREMISES (89 cc+currancal $ 100,000 CLpIM5»MADE X OCCUR � Lines Ir"sure - is an eligible. surplus lines insurer but ME47 EXP (Any one psraon) $ 51000 is not Aherwise licensed by The .Slane of I PERSONAL & ADV INJURY $1 0 0 0 , 0 0 0 I GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 01'Cla ms . t gu a teed. enCy, I.?7S'1Tlen1. F-1 P' 0� 01 ' Clams is no guaranteed. I PRODWCrs- cGMPJaPACG I POLICY ; LO�D - - - _ - -_ -- 5 AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT (Eaacodord) $ ANY AUTO I BODILY INJURY (Per person) S ALL OWNED AUTOS BODILY INJURY (Per awdant) S SCHEDULED AUTOS PROPERTY DAMAGE _ WIREDAUTOS (Peruccident} S NON-OWNED AUTOS I 5 5 UM'BRELLALIAB �OCCWR EACH OCCURRENCE S EXCESS LIAe CLAIMS•MADE AGGREGATE $ DEDUCTIBLE I 5 RETENTION 5 $ WORKERS COMPENSATION WOSIATU• OTH. k ELACHACCIDENT AND EMPLOYERS' LIABILITY ANY PROPRIETOR(PARTNER)EXECUTIVE YIN ToR r LIMITS ER $ OFFICERIMEMBER EXCLUDED? (Mandatory In NHI El NIA I E.L. DISEASE . EA EMPLOYEE $ Iiyes,dewIbeunder DESCRIP TIONOF OPERATIONS below E.L. DISEASE - POLICYLI MIT 5 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, AddMona3 Romano; Schedule, ILmore space Is required) SPECIAL EVENT DIV LASH ° - 5K AND 5 MILE RUN DATE OF EVENT: 11/132010 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. iCI,TY OF CENTERVILLE 1860 MAIN STREET ,CENTERVILLE, MN 55038 ACDRD 25 (2009109) AUTHORIZED REPRESENTATIVE docrnr k �TE?51�Ellt 0=71988 -2009 ACDRD CORPORATION, All rights reserved. The ACDRD name and logo are registered marks of ACDRD 29