Agenda - Council - 06/24/2014 - Laserfiche WebLink

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ACORLM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) 07/23/2013 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 lieu of such endorsement(s). PRODUCER Lee F. Murphy Inc. 2361 Highway 36 West St. Paul, MN 55113 INSURED PACT Charter School 7250 East Ramsey Parkway Ramsey, MN 55303-6902 CONTACT NAME: PHONE 651.644.7200 (,A/M�Lo. ExO: AADDRESS: INSURER A : INSURER B : INSURER C : INSURER D : I INSURER E : INSURER F : I FAX Nol: 651. 644. 9137 INSURER(S) AFFORDING COVERAGE NAIC # Hanover Insurance Company 22292 Massachusetts Bay Insurance Co 22306 COVERAGES CERTIFICATE NUMBER: 13-14 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 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 INSR ADDL SUBR WVD POLICY NUMBER I IMM/DDY/YYYY1 IMM/DD/YYYY) ZHX-A039869-00O 07/01/2013 07/01/2014 A A B TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n JERCOT- n LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS UMBRELLA LIAB SCHEDULED AUTOS NON -OWNED AUTOS EXCESS LIAB DED [X I RETENTION $ WORKERS �`OMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIV Y / N OFFICER/MEMBER EXCLUDED? I N / A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below OCCUR CLAIMS -MADE 0 ADX-A039906-00 07/01/2013 07/01/2014 UHX-A039870-0 07/01/2013 07/01/2014 LIMITS EACH OCCURRENCE $ UAMAGt IU KtN ItU PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG UUMbINEU SINGLt LIMI (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE WDX-A039932-00 07/01/2013 07/01/2014I X I TORS LIMITS I E.L. EACH ACCIDENT E.L DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ $ 1,000,000 $ UIH- ER 1,000,000 500,000 15,000 1,000,000 3,000,000 Included 1,000,000 1,000,000 500,000 500,000 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: 6701 Highway 10 NW, Ramsey MN. Certificate holder is included as additional insured with respect to the general liability, which includes waiver of subrogation and 30 day notice of cancel (10 Jay notice for nonpayment per MN State Statute). CERTIFICATE HOLDER CANCELLATION City of Ramsey 7550 Sunwood Drive NW Ramsey, MN 55303 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 Brian Becker/CATHY © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD 25 (2010/05)