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� ® <br /> ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> �....• 6/23/2016 <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: If the certificate holder is an ADDITIONAL INSURED,the policy(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 this certificate does not confer rights to the <br /> certificate holder In lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME: John Oscarson <br /> Ahmann-Martin PHONE952-947-9732 FAQ 952-947-9793 <br /> 7555 Market Place Drive <br /> Eden Prairie MN 55344 E-MAIL .joscarson@ahmannmartin.com <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> INSURERA:ACE USA 11111 <br /> INSURED J&JCO-1 INSURER B:Midwest Employers Casualty Co. 23612 <br /> J&J Contracting LLC INSURER c:Colony National Ins Co <br /> 573 Shoreview Park Road <br /> Shoreview MN 55126 INSURER D: <br /> INSURER E <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:251962112 REVISION NUMBER: <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 /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR ADDLSUBR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> A X COMMERCIAL GENERAL LIABILITY Y Y 627566297 002 3/1/2016 3/1/2017 EACH OCCURRENCE $1,000,000 <br /> DAMAGE TO RENTED <br /> CLAIMS-MADE X�OCCUR PREMISES Ea occurrence $100,000 <br /> MED EXP(Any one person) $5,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> POLICY Fx1 ECT LOC PRODUCTS-COMP/OPAGG $2,000,000 <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY Y Y H08450043 008 3/1/2016 3/1/2017 $ <br /> Ea a,Wident 1,000,000 <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS Per accident <br /> A X UMBRELLA L1ABX OCCUR 624064050 008 3/1/2016 3/1/2017 EACH OCCURRENCE $3,000,000 <br /> riEXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 <br /> DED I X I RETENTION$0 $ <br /> B WORKERS COMPENSATION Y 02-0001807 3/1/2016 3/1/2017 PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE — N/A E.L.EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 <br /> If Yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 <br /> A Professional Liability G27566297 001 3/1/2016 3/1/2017 Each Claim/Agg $1,000,000 <br /> C Excess Liability EXO 3034884 3/30/2016 3/1/2017 Each Occurrence $2,000,000 <br /> Aggregate $2,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> The following endorsements apply to the name(s)/project(s)listed below only if required by written contract or agreement: <br /> GENERAL LIABILITY: Blanket Additional Insured-Owners, Lessees, or Contractors per form ENV-3100(08/04); Primary and <br /> Non-Contributory per form ENV-3101 (08/04); Completed Operations per form ENV-3225 (10/08); Blanket Waiver of Subrogation per form <br /> ENV-3143(03/05). <br /> AUTOMOBILE: Blanket Additional Insured per form DA-6Z04a (06/14); Blanket Waiver of Subrogation per form CA0444 10/132. <br /> WORKERS COMPENSATION: Blanket Waiver of Subrogation per form TBG3233A. <br /> Hakanson Anderson and the City of Ramsey, MN are additional insureds with respect to General Liability. <br /> CERTIFICATE HOLDER CANCELLATION <br /> Hakanson Anderson SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 3601 Thurston Avenue ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Anoka MN 55303 <br /> AUTHORIZED REPRESENTATIVE <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />