HomeMy WebLinkAboutACORD Form 20191014-142435-38 DATE(MM/DD/YYYY)
ACS" CERTIFICATE OF LIABILITY INSURANCE
10/14/2019
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 have ADDITIONAL INSURED provisions or 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 Cheryl Michelli
NAME:
North Risk Partners A/CONNo Ext): (507)288-7600 a/c,No): (507)535-3130
2048 Superior Drive NW E-MAIL cheryl.michelli@northriskpartners.com
ADDRESS:
Suite 100 INSURER(S)AFFORDING COVERAGE NAIC#
Rochester MN 55901 INSURERA: Pioneer Specialty Ins.Co. 40312
INSURED INSURER B: Markel Insurance Company 28932
Tennis Sanitation, LLC INSURER C:
DBA:Tennis Roll-Off LLC,TBS LLC,Tennis Recycling LLC INSURER D:
PO Box 62
INSURER E
St Paul Park MN 55071 INSURER F:
COVERAGES CERTIFICATE NUMBER: 2019-20 Master 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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 TYPE OF INSURANCE POLICY EFF POLICY EXP
LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000
CLAIMS-MADE FX OCCUR PREM SDAMAGES Ea oNcurDrence $ 100,000
X Contractual Liability MED EXP(Any one person) $ 5'000
A Y CPP106511908 10/16/2019 10/16/2020 PERSONAL&ADV INJURY $ 1,000,000
GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2'000'000
X POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000
JECT
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
Ea accident
X ANYAUTO BODILY INJURY(Per person) $
A OWNED SCHEDULED CPP1064911 07 10/16/2019 10/16/2020 BODILY INJURY(Per accide nt) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5'000'000
A EXCESS LAB CLAIMS-MADE UMB1010634 07 10/16/2019 10/16/2020 AGGREGATE $ 5'000'000
DED I X1 RETENTION $ 10'000 $
WORKERS COMPENSATIONX1 STER ATUTE EORH
AND EMPLOYERS'LIA BI LI TY YIN 2,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
B OFFICER/MEMBER EXCLUDED? ❑ N/A 22-0417 02/15/2019 02/15/2020
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000
Ifyes.describe under 2,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
City of Oak Park Heights is an Additional Insured in respect to the General Liability coverage when required by written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
City of Oak Park Heights ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 2007
14168 N 57th St AUTHORIZED REPRESENTATIVE
Oak Park Heights MN 55082-2007 11� yY/
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