Agenda - Council Work Session - 01/21/2014

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FOR INFORMATIONAL PURPOSES ONLY 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 BILITY INSURANCE 11/1 /200 } ' AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 'E A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED policy(les) must be endorsed. if SUBROGATION 1S WAIVED, subject to 'dorsement. A statement on this certificate does not confer rights to the CONTACT NAME: Certificate Department PHONE (952)707 -8200 FAX (952) 890 -0535 mm No mo: IAtC, Noi: E -MAIL ADDRESS: certificatesekainsurance.com PRODUCER 00006299 CUSTOMER ID N: INSURER(5) AFFORDING COVERAGE NAIC N INSURER A :SSeCUra Insurance 22543 INSURER B : OCCUR INSURER C : INSURER D : X INSURER E : $ 250,000 INSURER F : CLAIMS -MADE THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PtKIUU 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 TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD 11/18/2010 (MMIDDIIYYYY) 11/18/2011 LIMITS ITS EACH OCCURRENCE $ 1,000,000 A GENERAL UA COMMERCIAL GENERAL LIABILITY OCCUR BP- 003156589 -9 X DMAGE TO PREMISES (Ea $ 250,000 CLAIMS -MADE X MED EXP (Anyone person) $ 5,000 PERSONAL 8 ADV INJURY $ Included GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n JE T fl LOC PRODUCTS - COMP!OP AGG $ 2 , 000 , 000 $ X A AUTOMOBILELIABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS A 003156590 - 9 11/18/201011/18 /2011 COMBINED SINGLE LIMIT (Ea exider t) $ 1, 000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X 8 X $ A X UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS -MADE CU- 003156592 11/18/2010 11/18 /2011 EACH OCCURRENCE $ 5,000,000 AGGREGATE s . 5,000,000 DEDUCTIBLE RETENTION $ 10,000 $ X $ . A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS Y! N NIA RC 003156591 - 9 11 /1B /x01011/18/2011 Y WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 500, 000 N E.L. DISEASE - EA EMPLOYEE $ 500, 000 below E. L. DISEASE - POLICY LIMIT 8 500,000 B Professional Liability LHR724124 11/18/201011/18 /2911 Each Claim 2,000,000 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) ACORI CERTIFICATE OF LIA THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONL CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITU REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the the terms and conditions of the policy, certain policies may require an e certificate holder in lieu of such endorsement(s). PRODUCER Kraus- Anderson Insurance 420 Gateway Boulevard Burnsville DAB 55337 -2790 INSURED Landform Professional Services, LLC. 105 Fifth Ave. South Suite 513 Minneapolis COVERAGES ACORD 25 (2009/09) INS025 (200909} MN 55401 CERTIFICATE NUMBER:10 - Certificate The ACORD name and logo are registered marks of ACORD REVISION NUMBER: -2009 ACORD CORPORATION. All rights reserved.