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AC®RD® DATE (MMIDD/YYYY) 8/28/2012 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 Ileu of such endorsement(s). PRODUCER CERTIFICATE OF LIABILITY INSURANCE Loretz-Johnson Agency, Inc, 224 East Main St., Suite 203 Anoka INSURED Independent Auto Service 6745 Hwy 10 NW MN 55303 Ramsey MN 55303 COVERAGES CERTIFICATE NUMBER:12-13 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 ANCR Swvi POLICY NUMBER iMMIDD EFFI IMM/DD( Y1 LTR$TYPE OF INSURANCE POLICYLIMITS (INC.FAX (763)421-6530 Not: NAIC 0 18988 GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY A CLAIMS -MADE X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY I—tI !IPA, 1 I LOC AUTOMOBILE LIABILITY ANY AUTO _ ALL OWNED AUTOS HIRED AUTOS UMBRELLA LIAB EXCESS LIAB SCHEDULED AUTOS NON -OWNED _ AUTOS OCCUR CLAIMS -MADE DED j RETENT ON $ WORKERS OPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? n N I A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below 9640425801 NpMEACT Greg J Peterson IIPHHHON AA�iIpf NoFxIl• (763) 421-1290 O Aa'Ess: gregpeterson@live .com INSURER(S) AFFORDING COVERAGE INSURER A;Auto Owners Insurance Company INSURER B: INSURER C : INSURER D : INSURER E INSURERF: 8/15/2012 $/15/2013 EACH RTEtic DAMA(E7 l O KEN I ED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ 1,000,000 $ 300,000 $ 10,000 $ 1,000,000 $ 2,000,000 $ 2,000,000 $ COMBINED SINGLE LIMIT(Ea $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE I $ (Per accident) I Is I EACH OCCURRENCE Is I AGGREGATE Is I $ WC STATU• OTH- TORY IMITA FR E.L. EACH ACCIDENT JJ $ I E.L. DISEASE - EA EMPLOYEE $ I E.L. DISEASE - POLICY LIMIT I $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) This certificate or memorandum of insurance does not affirmatively or negatively amend, extend, or alter the coverage afforded by the insurance policy. Certificate is for information purposes and is intended to provide a summary of coverage at the time of issuance. CERTIFICATE HOLDER City of Ramsey 7550 Sunwood Drive NW Ramsey, MN 55303 CANCELLATION 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 Jeremy Loretz/JJL - ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS026 (201005).01 The ACORD name and logo are registered marks of ACORD