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4
<br />AW o CERTIFICATE OF LIABILITY INSURANCE
<br />DAx212oi )
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />r BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />'' REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. .
<br />..: IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. It SUBROGATION IS WAIVED, subject to
<br />': the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />(, certificate holder in lieu of such,endorsement(s).
<br />: PRCDI CER
<br />)Ele* encs Management Group
<br />'os.. Office Box 64016
<br />i°',
<br />'Satizt Paul MN 55164
<br />CONTACT TracyHaile CISR
<br />NAME: ,
<br />a/Co.NNo. Ext} (651) 379-7800 (WC, Ho): (651)379-1801
<br />E-MAILESS: thaile@bearence.com
<br />ADDR
<br />PRODUCER 00000384
<br />CUSTOMER ID #-
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURED
<br />,. _
<br />:City of Ramsey
<br />7550 Sunwood Drive .
<br />Ramsey MN 55303
<br />INSURERA League of Minnesota Cities
<br />LIABILITY
<br />OCCUR
<br />INSURER B :
<br />INSURER C :
<br />1/1/2012
<br />INSURER D:
<br />EACH OCCURRENCE
<br />INSURER E :
<br />X
<br />INSURERF:
<br />$ 50,000
<br />CERTIFICATE NUMB 2012-2013 ALL
<br />...,. THIS -IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />-, pXGLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSR
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />(MMIDDIYYYYUMMIDDIYYYY)_
<br />POLICY EXP
<br />LIMITS
<br />1,
<br />"'
<br />�-
<br />• Ai
<br />,
<br />..
<br />P:fa,
<br />GENERAL
<br />LIABILITY
<br />COMMERCIAL GENERAL
<br />LIABILITY
<br />OCCUR
<br />CMC 33697
<br />1/1/2012
<br />1/1/2013
<br />EACH OCCURRENCE
<br />$ 1,500,000
<br />X
<br />-DAMAGE TO RENTED
<br />PREMISES (Ea occurrence)
<br />$ 50,000
<br />-?-
<br />X CLAIMS -MADE
<br />MED EXP (Any one person)
<br />$ Excluded
<br />'-
<br />PERSONAL & ADV INJURY
<br />$ Included
<br />,
<br />lSEN
<br />n
<br />GENERAL AGGREGATE
<br />$ 0
<br />L AGGREGATE LIMIT APPLIES PER:
<br />POLICY n JECO-f n LOC
<br />PRODUCTS-COMP/OPAGG
<br />$ 2,000,000
<br />$
<br />.',!•'''••••
<br />st,.
<br />4:
<br />?A.
<br />...6.1./ TON{QBILE
<br />.
<br />i•�
<br />LIABILITY
<br />ANY AUTO
<br />AVL OWNED AUTOS
<br />:. '.
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />NON -OWNED AUTOS
<br />CMC 33697
<br />1/1/2012
<br />1/1/2013
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$ 1,500,000
<br />•—
<br />-....
<br />BODILY INJURY {Par person)
<br />$
<br />BODILY INJURY (Pet accident)
<br />$
<br />PROPERTY DAMAGE
<br />(Per accident}
<br />Uninsured motorist combined
<br />$
<br />Underinsured motorist
<br />$
<br />.-
<br />.UMBRELLALIAR
<br />EXCESSUAB
<br />_
<br />OCCUR
<br />CLAIMS -MADE
<br />EACH OCCURRENCE
<br />$ -
<br />AGGREGATE
<br />$
<br />' '
<br />DEDUCTIBLE
<br />RETENTION $
<br />$
<br />'d
<br />.
<br />$
<br />...
<br />2
<br />'
<br />�j /. �
<br />WORKERS COMPENSATION...WC
<br />AND EMPLOYERS' LIABIUTY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />(MFory dndaIn NH)EXCLUDED?
<br />.Ify es, describe under
<br />:a.ESCRIPTIDN OF OPERATIONS
<br />•
<br />YIN
<br />—`j
<br />I I
<br />NIA
<br />0200031129
<br />1/1/2012
<br />1/1/2013
<br />STATU- OTH-
<br />TORY LIMITS ER
<br />E.L. EACH ACCIDENT
<br />$ 1,500,000
<br />•[
<br />below
<br />E.L. DISEASE - EA EMPLOYEE
<br />$
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,500,000
<br />.
<br />Dp71O
<br />"E$Cp N OF OPERATIONS / LOCATIONS! VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
<br />: Corn
<br />mect Anoka County Project.
<br />..::., _. ..r.
<br />Pe4i tible - $10,000/$20,000/$1,000.
<br />;-,,,b,;t.
<br />EFT1FICATE HOLDER
<br />r .
<br />County of Anoka
<br />2100 3rd Avenue
<br />•:• Arioka, MN 55303 ,.
<br />*.ACOAD 25 (2009/09)
<br />)NS025 (200909}
<br />CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />T Haile, CISR/HAILE
<br />01988-2009 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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