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HomeMy WebLinkAboutCOI 16-17 ACC)® CERTIFICATE OF LIABILITY INSURANCE D/ `°° 2/16/16/201166 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 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). PRODUCER CONTACT Trac Haile, CISR t� NAME: y Bearence Management GroiPHONE n , (651)379 .7800 FAX RECEIVED E-MAIL (651)374-7805 2010 Centre Pointe Blvd .thane@bearence.com INSUI AFFORDING COVERAGE NAIC# Mendota Heights MN 55120 _ INSURERA:Lea ue of Minnesota Cities INSURED 1 INSURER B City Of Bayport INSURER C: 294 North Third StreetCity of Oak Park Heights INSURER P —AM PM INSURER E , Bayport MN 55003 INSURER F COVERAGES CERTIFICATE NUMBER:2016-2017 ALL 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 I A UL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMfODlYYYY MMfDDfYYYY GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ Included A X I CLAIMS-MADE 7 OCCUR CMC 38874 3/30/2016 /30/2017 MED EXP(Any-one person) S 2,500 PERSONAL&ADV INJURY $ included GENERAL AGGREGATE S 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 3,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 2 000 000 A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED Cl 38874 /30/2016 /30/2017 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Peracc�dent Uninsured motorist.combined $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ 1,000,000 A X EXCESS LIAR x CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ L 8795 /30/2016 /30/2017 1 $ • WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS I ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,500,000 NA OFFICER/MEMBEREXCLUDED? 0200024934 4/1/2016 4/1/2017 (Mandatory in NH) E DISEASE-EA EMPLOYE $ !f yes. &SC'Ibe Lmder DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIPA T 5 1,500,000 A Auto Physical Damage CMC 38874 /30/2016 /30/2017 Comp.&Coll.Ded. 52,500!$10,0001$1,000 DESCRIPTION OF OPERATIONS f LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE: Fire Contract. Oak Park Heights is included as an additional insured for general liability as required by written contract or written agreement with regards to the fire contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Oak Park Heights ACCORDANCE WITH THE POLICY PROVISIONS. 14166 Oak Park Blvd. N. AUTHORIZED REPRESENTATIVE PO BOX 2007 Oak Park Heights, MN 55082 _ T Haile, CISR/HAILE ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).x1 The ACORD name and logo are registered marks of ACORD