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ACORt,, CERTIFICATE OF LIABILITY
<br />INSURANCE DATE(MMIDDIYYYY)
<br />09/30/2014
<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 />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: f the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to -
<br />the terms and conditions of the policy, certain policies may require an endorsement A statement on thle certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s). _
<br />PRODUCER
<br />11. Robert Anderson & Assoc. , Inc.
<br />8201 Norman Center Drive
<br />Suite 220
<br />Bloomington, MN 35437
<br />CONTACT
<br />NAME-
<br />FHEI. 952.893.1933 Fax
<br />C No, am � {Arc, N•}: 952.893.1819
<br />ADDRESS:
<br />thil
<br />INSURERIS) AFFORDING COVERAGE
<br />NAICIt
<br />INSURER A: Travelers
<br />GENERAL
<br />INSURED WSB & Associates, Inc.
<br />701 Xenia Avenue South
<br />Ste. 300
<br />Minneapolis, MN 55416
<br />INSUREtt6: XL Specialty Insurance Co.
<br />—
<br />INSURER C:
<br />INSURER O ;
<br />X
<br />INSURER E:
<br />MEDEXP (Any one person)
<br />INSURER F :
<br />: JLU/J.4-J.S AI 1 Lines
<br />REVISION NUM
<br />H - IS TO CERTIFY THAT HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN SSUEDT• THE INSU- D NA I ' BOVE FOR THE P. ICY •ERIOD
<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 />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />LTR
<br />TYPE OF INSURANCE
<br />IMRE
<br />lmaTR
<br />yWVD
<br />POUCY NUMBER
<br />680 8388R315 1410/0112014
<br />POLICY EFF
<br />{MMIDDIYYYY)
<br />POLICY EXP
<br />(HIMIOOIYYYY)
<br />10/01/2015
<br />LIMITS
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />A
<br />GENERAL
<br />LIABILITY
<br />COMMERCIAL GENERAL LIABILITY
<br />X
<br />PREMISES (Ea occurrence)
<br />$ 1,000,000
<br />CLAIMS -MADE
<br />X
<br />OCCUR
<br />MEDEXP (Any one person)
<br />$ 10,000
<br />PERSONAL a ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GENT.
<br />—1
<br />AGGREGATE LIMITAPPLIES PER:
<br />POLICY n !l n LOC
<br />PRODUCTS- COMP/OP AGO
<br />$ 2,000,000
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ANYAUTO
<br />AALLOWNED
<br />HIRED AUTOS
<br />SAUTHEEDDULED
<br />NAON'OWNED
<br />BA 8391R701 1410/01/2014
<br />10/0112015
<br />{Esccdent] INULELIMIT
<br />$ 1,000,000
<br />X
<br />—
<br />BODILY INJURY (Per person)
<br />$
<br />BODILYINJURY(Pe► accident)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />(Far accident)
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB 1 X
<br />EXCESS LIAB
<br />OCCUR
<br />CLAIMS -MADE
<br />CUP 8404R215 1410/01/2014
<br />10101/2015
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5.000,000
<br />DED RETENTION$
<br />$
<br />A
<br />WORKERS
<br />ANDEMPLOYERS'LIABILITY
<br />OFFICER/MEMBER
<br />(Mandetoly
<br />livyeess
<br />DESCRIPTION
<br />COMPENSATItkIWC
<br />In NH)
<br />describe under
<br />OF OPERATIONS
<br />YIN
<br />NIA
<br />UB 3930172 0 14
<br />10/01/2014
<br />10/0112015
<br />STATU pT
<br />X TORY LIMITS ER
<br />EL EACHACCIDENF
<br />$ 1,OOD,000
<br />CUTIVC� I
<br />II
<br />E,L. DISEASE - EA EMPLO' EE
<br />$ 1, 000, 000
<br />below
<br />E.L. DISEASE - PDIJCY LIMIT
<br />$ 1, 000 00 I
<br />B
<br />Professional Liability
<br />DPR971841910/0112014
<br />10/01/2015
<br />Pach Claim/ $5,000,000
<br />Annual Aggregate $10,000,000
<br />DESCRIPTION OF OPERATIONS! LOCATIONS !VEHICLES {AIIach ACORU 101, Additional Remarks Schedule If more space Is required}
<br />•
<br />This certificate or memorandum of insurance does not affirmatively or negatively amend, extend,
<br />or alter the coverages afforded by the insurance policies.
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />Township of Lent
<br />33155 Hemingway Ave
<br />Step', MN 55079
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE OEUVERED IN
<br />ACCOROANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />3)A01144A. ILL. a�+ d2r a
<br />01985-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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