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AC R 0311812/18/2CERTIFICATE OF LIABILITY INSURANCE DA 0220 <br />THIS.CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION ONLYAND COHFERS.NO RIGHTS UPON THE CERTIFICATE HOLDER, TH15 <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED pirbvislons or be endorsed. <br />If SUBROGATION IS. WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement.on <br />this certificate does not confer rights. to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />rrstnational Insurance <br />iiD55 NeSt7ltAjerICIQS, Inc. <br />324.OakSt, PO Box 130 <br />Farmington MN 55024-0130 <br />.CONTACT Sarah Kruse <br />-NAME: <br />PHONE. (851).460-6014 FAIC No r. (651) 460-6625 <br />AIC oRytim <br />ADDRESS; Skruse@nesbitagencies.Com <br />INSURERS) AFFORDING COVERAGE <br />NAIL M <br />1NSURERA: League of Minnesota Cities Insurance Trust <br />INSURED <br />City of Gem Lake <br />4200 Otter Lake Road <br />Gem. Lake MN 55110-3763. <br />INSURER B : <br />INSURER C <br />INSURER D : <br />INSURER E <br />INSURERr: <br />COVERAGES CERTIFICATE NUMBER: 2622-2023 REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCELISTED BELOW HAVE. BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 7HEPOLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF.ANY CONTRACTOR OTHER DOCUMENT VVITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED:OR MAY PERTAIN, THE INSURANCEAFFORD ED BY THE POLICIES DESCRIBEO HEREIN ISSUBJECTTOALLTHE TERMS, <br />EXCLUSIONSAND CONDITIONS OF. SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />1NSR <br />LTR <br />TYPE OF INSURANCE <br />INSD <br />INVD <br />POLICY NUMBER <br />MMm CY EFF <br />CY EXP <br />MM1DDNYYY <br />LIMITS <br />X <br />CC.O/MMERCIALGENERALLIABB.JiY <br />El+CHOCCURRENCE <br />8 2,000,000 <br />PREMISES Eaaccurrence <br />$ INCLUDED <br />%' CLAIMS -MADE OCCUR <br />MED EXP (Any one person <br />$ EXCLUDED <br />A <br />Y <br />Y <br />CMG 1.002254-6 <br />04/01/2022 <br />041D112023 <br />PERSONAL &ADV INJURY <br />g INCLUDED <br />GERLAodKEGATE Lim IT APPLIES PER <br />GENERAL AGGREGATE <br />$ <br />PRODUCTS-COMPIOPAGG <br />S 3i000,000 <br />POLICY PROM LOC <br />JECTOTHER; <br />S. <br />AUTOMOBILE LIABILITY <br />7.daadntSL E LIMIT <br />COMBINE <br />2,000,000 <br />BODILY INJURY (Per person) <br />S. <br />ANY AUTO <br />BODILY INJURY (Perauldent). <br />S <br />A <br />OWNED. SCHEDULED <br />AUTOSONLY AUTOS <br />HIRED. NON -OWNED <br />AUTOS -ONLY AUTOS ONLY <br />Y <br />Y <br />CMC 1002254-6 <br />04/01/2022 <br />0410112023 <br />PROPERTY DAGE <br />Per acdif entMA <br />S <br />S <br />UMBRELLA WAS. <br />OCCUR <br />EACH OCCURRENCE <br />S <br />AGGREGATE <br />S <br />EXCESS.LIAB <br />"IMS-MADE <br />OED I I RETENTIONS <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY. YIN <br />ANY.PROPRIETOWPARTNERIEXECU IIVE�� <br />OFFICERIMEMSER EXCWDED7 <br />(Mandatory in NMI <br />NIA <br />Y <br />1002682-6 <br />05/16/2022 <br />D511B12D23 <br />iC I STATUTE . ERA <br />E.L. EACH ACCIDENT <br />$ 1 �SUO;OOD <br />E.L. DISEASE EA EMPLOYEE <br />$ <br />E.L. DISEASE -POLICY LIMIT <br />$ 1,600000 <br />Ifyes, describs under <br />DES CRIPTION-OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS I LOCATIONS I YEHICLES tACORD'101: Addltlonal Ram arks Schedule, may: be attached if mare space Is required) <br />As respects all contracts and:agreementwith BNSF Railway Company, and Jones, Lang, La Salle GIobaI Services.Ind.,.the certificate holder is included as a.n <br />additional covered party for Municipal SoIII ihy Injury,. Property Damage, and Personal Injury &.Automobile Liability and the coverage is primanrand <br />non-contributory. <br />UVarver of Righls•of Subrogation hs afforded to the certificate holder foe Municipal Bodily Injury, Property Damage, and.Personal Injury:& Automobile Liability <br />and Workers Compensation. The Municipal Bodily Injury,,Property Damage, and Personat Injury coverage docurrieni; including Contractual L.iability.does <br />not include any exclusions er Iimitations fn connection with operations cn or within 50 feet of a railroad. Municipal Liability Reti'oactive.Date 7 4/1/1987 <br />CERTIFICATE HOLDER CANCELLATION <br />.BNSF Railway Company clo CertFocus <br />PO Box 140528 <br />Kansas -City <br />Mo 64114 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE V41LL BE DELIVERED IN <br />ACCORDANCE WITH -THE POLICY PROVISIONS; <br />.AUTHORIZED REP RESENTATWE: <br />a 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The AGO RD name. and logo are registered marks of ACORD <br />