HomeMy WebLinkAboutCOI 17-18 ACo CERTIFICATE OF LIABILITY INSURANCE DATE`MMIDD''YYYY)
` 3/24/2017
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 staternent on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER No IFI
ATracy Haile, CIC, CISR
-- - —
Bearence Mgmt Group PRONE (651)379-7800 FAX ) (550379-7901
2010 Centre Pointe Blvd E-MAIL
ADDRESS:thaile@bearence.com
g {?( INSURER($;AFFORDING COVERAGE NAIL#
Mendota Heights MN 5 120 RL RLIJ fSURER
RA:Lea ue ofMinnesota Cities
INSUREp - --_ ._ ` __ _City of Bayport RC:
294 North Third Street RDE
Bayport MN 5003 R F
COVERAGES CtTIFlCATE N.UIVISR - 17T,L REVISION NUMBER:
THIS IS TO CFRTiFY THAT THE POLICIES OF INSURANCE LI t"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- -- ---- -- ...-- _.�_..-7_'_
-'ADDU SUBR.-� -
LTR TYPE OF INSURANCE POLICY EFF PM/DD(EXP
WVQPOLICY NUMBER MMIpplYYYY MMlpp1YYYY LIMITS
{ RAL LIABILITY EACH OCCURRENCE $ 2,000,000
COMMERCIAL GENET I DA-s ';!_TO REN I"E0.
X CO
A I X CLAIMS-MADE OCCUR i PREMISES!.Fa ocaj,,enceS Included
IIf J
! CMC 1001789-1 3/30/2017 3/30/2018 MEDLXP;AnyonePerson) -1$ 2,500
_-' ------ -_. _-.. ------ - - '., PERSON,,L a ADV_INJURY - S Included
N'L AGGREGATE LIMIT APPLIES PER.
- -- GENERAL AGGREGATE $ 0
X POLICY ECT LOC _ - - -
PRODUCTS-COMPiOPAGG $ 3,000,000
OTHER: FatlL•c to Supply Claim Lim,: $ 3,000,000
AUTW,108!LE L!Af3FLITY COMBINED SINGLE LIMIT $ 2,000,000
A X ANY AUTO BODILY INJURY�Per person) $
ALL OWNED -_-i SCHEDULED --
!__ I AUTOS L�'AUTOS CMC 1001789-1 3/30/2017 3/30/2018 !BODILY INJURY Wer accident), $
! NON-OWNED -_- - --- -- -
HIRED AUTOS PROPERTY i AUTOS (Per PERT $
Is
UMBRELLA LIARL , OCCUR ' I EACH OCCURRENCE !$ 000,000
A F X EXCESS LAB X CLA!MSWADE! I AGGREGATE
_ $ _ 1,000,-000
DFD REIENTION$ MEL 1001790-1 3/30/2017 3/30/2018 $
WORKERS COMPENSATION � I PER DTH-
ANO EMPLOYERS'LIABILITY YIN ,.X STATUTE .__,..ER
OFFArY PROP�i LR1EXCLUDEi_XECUTkVE r�; � E.L.EACH ACC0ENT $ 1,500,000
'OFFiC RJh4�h EcR EXCLUDED? jNIA, —_ -...—
A '(Mandatory in NH) WC 1002116-1 4/1/2017 4/1/2018 E.L-DISEASE EA EMPLOYEE;$
f yes .. nder !
DESCRIPTION OF OPERATIONS below f E.L.DISEASE-POLICY LIMIT s 1,500,000
A :Auto Physical Damage ICMC 1001789-1 3/30/2017 3/30/2018 Comp-B Coll.Deds.
j $2,500!510,000/$1,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached 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
Oak Park Heights THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
14168 Oak Park Blvd. N, ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 2007
Oak Park Heights, MN 55082 AUTHORIZED REPRESENTATIVE
T Haile, CIC, CISR/HA ���
OO 1888-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
IN S025(201401)