HomeMy WebLinkAboutCertificate of liability insurance- Raleigh AC -
LIABILITY CERTIFICATE OF ' DATE,(MMlDDfYYYY)
2/8/2013
THIS CERTIFICATE IS ISSUED AS A MATTER OF IN'FORMATI'ON 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 endorsemeint(s).
..PRODUCER ......CONTACT
NAME. 001.
_ ,.m . ...._..._.
Fester and Meister Agency PHONE .(651)430-1665 FAx ___..(651)430-1908
6750 Stillwater Blvd.l. N. E-MAIL A/C No
....
P. 0. He 469 ADDRES
INSURER(5 AFFORDING COVERAGE NAIL#
Stillwater MN 55082 INSURERA:Acuit Insurance Co. 14184
INSURED .._... e___...� � __ _.. ..._..._. .._..
INSURER B
Raleigh 'T'ruckin. Inc INSURER C:
_..._. .._..... ...�.�_._........ _.... _m..........
15250 100th 5t. INSURER D:
.n.... ._._.. _............... .._m._ m_......__. __............_...._..._
P,4T Box. $ X 2'61 ...INSURER E
..-.-.. ._........... � ........ ..__ _..._. ........ ......... . _...
Stillwater I:1t*7 55082 INSURERP:
COVERAGES CERTIFICATE NUMBER:CT 132803516 REVISION NUMBER;
1mI°IBS IS TG C FF TiFY THAI °rFIE PCLICIE'S(3F INSURANCE L.IS°ELl BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE [""OR THE POLICY PERIDD
IN[JI(AFEfJ NOTI All I1S'I`ANL)ING ANY RECDIJIREMF:NT, "T"E R,M (7R CONDFTI.JN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO V"aHICI l THIS
C[.:RIIFICIATE:, IUlAY BE ISSUED OR MAY PEz'RTAIN„ 'rl�E INSl.1RANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT "TO ALL THE TERMS„
EX( I.,USIONS/NL ((JNnll"IONS C)F SIJCII N DLICIES. LIMI°I'S SII()J/N MAY HAVE BEEN REDUCED BY PAID CLAIMS.
__--_-
LTR.
TYPE Or INSURANCE BRI k'OLICYTT _..i-OLIOY EXp...�...._ ....,....._...._...... _,�..m.,.....____..._.,_......__ ..._
POLICY NUMBER MMdDDPYYk'Y R M/D177YYYY LIMITS
GENERAL LIAl31'1_I"tY
EACH OCCURRENCE '.$ 1 ,000,000
Coti1fu1CLi2Ctl,+'4.4.r DE IdAI.I VOCC J MFQY k XI'QAny one person) ._.m ..._,. 100,000
.._ 00^�D...:
A � CwI.AlIW23-Iv1AIYI 0(%(:l.Il) '..... X LT131E7.. ./:)8/2013 /18J201rI PhIC�YSfS Euaaasuarrrrt�rc �r 1pp Op'p,.
&ADVINJURY `I 1 ,000,006
.... ....-----._........... GE:NIRALA€GREGAFF G 2,000,000
4'Oi.UCYI C F ROl"A6 G'G.YI e FB""R. . ...
afl NI AC' _ a7 PRODUCTS $ 2,000,000
l I@MI i(
$
AU I'OVMOaOLE LIA13I1.11"Y
._. AU OS OWNED _.._�....AJffSC7SUI..E1) � /7,6/2U13 /1k3{2Q1,�1 !.)C}t?II...... it l YQPer'accocjeri � D.. ppp ppp
�f 8471711 Y INJURY I s n �Ersadro
18161 ),6
NON-OWNFI) -_ _�._�.----_......__..._.._....._..
E TIRED Au roS AUTOS ROPL RTY DAMAGE
10 Per accident)
Undennsumecl molanst BI s It $ 1 000 000
s UMBRELLA 1_IAD OCCUR EACI I OCCURRENCE. $..... 3...000,000
EXCESS LIA®. .._. _. ........ ....._
A .._._.... .- CLAIMS-MADE AGGREGATE $ 3,000,000
13ED RcTPNrICN$ 15161 ./16/2013 2/18/2 0 14
,siy AND EMPLOYERS'COMPENSATION LI LIABILITY VJC STA°I"U- Ori l-
RNDEMPLOYERS"LIABIIPTY Y d N ''.......-- T. _'�...I�Ml t 5 ......... .,�,?...m....._.__....
ANY r RCPRIEroRrl>nRnNit:RrExEC rlvi. E 1. EACH ACC,OENI° $ 500,000
OFFICERIM MBf;R EXCLUDED?
��
NIA _.. .
(Mandatory in NH) 1.816]. /x.8/2013 /18/2011 E.I.. DISEASE: CArBylfl.C)YEI= $ .5pp'...�?pp
If yes descnhc undue ._E ......u..5
_... UI.SCRIP'TION OF OPI RATIONS below F.I.DISEASE-POI POLICY LIMIT VE 5pp .ppp
. ................_ ___..._.. . __tn_........._w
DESCRIPTION OF OPERATIONS!IL.00ATIONS 1 VEHICLES (Attach ACORD 121,Additional Remarks Scheduie,if more space is required)
City of Oak Park. Heights as additional insured
CERTIFICATE HOLDER CANCELLATION
439--0574.
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,
141.68 NORTH 57TH STREET
OAK PARK HEIGHTS, MN 55082 AUTHORIZED REPRESENTATIVE
Steven [Seister/STEVE
ACORD 25(2010/05) @ 1998-2010 ACORD CORPORATION. All rights reserved.
INS025 t201005S.01 The ACORD name and Pogo are registered marks of ACORD