12/13/11 - Laserfiche WebLink

Home

® ,4 CERTIFICATE OF LIABILITY INSURANCE 1DATE (MMIDDlYYYY} 11/18/2010 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(les) must be endorsed. if SUBROGATION 1S 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). CONTACT Certificate Department PRODUCER I NAME: �HONE Ez:(952)707-8200 ADDREss: certificates@kainsurance.com161- 1 rec. Not: (952)990-0535 PRODUCER 00006299 CUSTOMER ID e' DIN 55337 - 2 7 90 INSURERIS) AFFORDING COVERAGE NAIC r INSURER A:SeCura Insurance 22543 Kraus -Anderson Insurance 420 Gateway Boulevard Burnsville INSURED Landform Professional Services, LLC. 105 Fifth Ave. South Suite 513 Minneapolis MN 55401 INSURER B : 1 INSURER C : I INSURER D : I INSURER E I INSURER F : COVERAGES CERTIFICATE NUMBER:10-11 Certificate 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 WTH 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 ,OLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ' ADDLSUBR POLICY EFF POLICY EXP yyLIMITS TYPE OF INSURANCE IN$R Vp POLICY NUMBER 'MMIY IODIYYYYI IMMIDDYYY) 1,000,000 GENERAL LIABILITY EACH 9CC� R NCE $ DAMAGE TO RENTED 250,000 X COMMERCIAL GENERAL LIABILITY I PREMISES fEa occurrence) $ A CLAIMS -MADE OCCUR BP-003156589-9 11/18/2010 11/18/2011I MED EXP (Anyone person) $ 5,000 I PERSONAL & ADV INJURY $ Included IGENERALAGGREGATE $ 2,000,000 I PRODUCTS-COMPIOPAGG 2,000,000 X GEN'L AGGREGATE LIMIT APPLIES PER: X 1 POLICY n jT n LOC AUTOMOBILE LIABILITY X A X x ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X UMBRELLA LIAB EXCESS LIAB x OCCUR CLAIMS -MADE DEDUCTIBLE A X RETENTION $ 10.000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y! N ANY PROPRIETORIPARTNERIEXECUTIVE n NlA OFFICERIMEMBER EXCLUDED? (Mandatory In NH) It yes, describe under DESCRIPTION OF OPERATIONS below B Professional Liability A-003156590-9 CU-003156592 I$C-003156591-9 LHR724124 11/19/2010 11/18/2011 11/18/2010 11/18/2011 11/18/2010 11/18/2011 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) $ $ $ $ PROPERTY DAMAGE (Per accident) 1,000,000 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ . 5,000,000 11/18/2010 11/18/2011 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) CERTIFICATE HOLDER FOR INFORMATIONAL PURPOSES ONLY CANCELLATION $. WC STATUS I I OER T E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ Each Claim Aggregate 500,000 500,000 2,000,000 2,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE J Voerster/CARLEY ACORD 25 (2009/09) 1 NS025 (2o0sos} 01988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD