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Agenda - Council - 09/10/2019
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Agenda - Council - 09/10/2019
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3/17/2025 2:33:33 PM
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Meetings
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Agenda
Meeting Type
Council
Document Date
09/10/2019
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AC[]RD` <br />CERTIFICATE OF LIABILITY INSURANCE <br />Page 1 of 1 <br />DATE (MM/DD/YYYY) <br />12/19/2018 <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 have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Willis of Minnesota, Inc. <br />c/o 26 Century Blvd <br />P.O. Box 305191 <br />Nashville, TN 372305191 USA <br />INSURED <br />RJM Construction, LLC <br />830 Boone Avenue N <br />Golden Valley, MN 55427 <br />CONTACT <br />NAME: <br />PHONE <br />No. Ext): <br />MAIL certificates@willis.com <br />ADDRESS: <br />1-877-995-7378 <br />INSURER(S) AFFORDING COVERAGE <br />FAX 1-888-467-2378 <br />(A/C, No): <br />NAIC <br />INSURERA: Zurich American Insurance Company <br />16535 <br />INSURERB: Starr Indemnity & Liability Company <br />38318 <br />INSURERC: American Guarantee and Liability Insurance <br />26247 <br />INSURERD: Steadfast Insurance Company <br />26387 <br />INSURER E : <br />INSURER F <br />COVERAGES <br />CERTIFICATE NUMBER: W9495656 <br />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 <br />LTR <br />TYPE OF INSURANCE <br />AWL <br />INSD <br />SUER <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />(MM/DDJYYYY) <br />POLICY EXP <br />IMM/DD/YYYYl <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />CLAIMS -MADE <br />X <br />OCCUR <br />DAMAGE TO RENTED <br />PREMISES (Ea occurrence) <br />$ 100,000 <br />A <br />MED EXP (Any one person) <br />$ 5 , 000 <br />Y <br />Y <br />GL00084162-04 <br />01/01/2019 <br />01/01/2020 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />7 <br />POLICY <br />X <br />PE <br />LOC <br />PRODUCTS - COMP/OP AGG <br />$ 2,000,000 <br />OTHER: <br />$ <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />(Easderrtl <br />_ <br />$ 1,000,000 <br />X <br />ANY AUTO <br />—1 <br />BODILY INJURY (Per person) <br />$ <br />A <br />OWNED <br />AUTOS ONLY <br />SCHEDULED <br />AUTOS <br />Y <br />Y <br />BAP0084161-04 <br />01/01/2019 <br />01/01/2020 <br />BODILY INJURY (Per accident) <br />$ <br />X <br />HIRED <br />AUTOS ONLY <br />x <br />NON -OWNED <br />AUTOS ONLY <br />PROPERTY E <br />(Psr=Wan) <br />$ <br />$ <br />B <br />UMBRELLALIAB <br />X <br />— <br />OCCUR <br />EACH OCCURRENCE <br />$ 5,000,000 <br />X <br />EXCESSLIAB <br />CLAIMS -MADE <br />1000584789191 <br />01/01/2019 <br />01/01/2020 <br />AGGREGATE <br />$ 5,000,000 <br />DEDJ f RETENTION $ <br />$ <br />WORKERS <br />AND EMPLOYOERS' LIABILITY <br />X <br />l <br />STATUTE 1 EER <br />C <br />Y/ N <br />ANYPROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBEREXCLUDED? n <br />N <br />WC0084166-04 01/01/2019 <br />01/01/2020 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />El. DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />D Contractors Pollution & <br />Professional Liability <br />EOC 0086225-04 01/01/2019 <br />01/01/2020 <br />(Aggregate <br />Each Claim <br />$5,000,000 <br />I$5,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Additional Insured is included as an Additional Insured as respects to General Liability and Auto Liability as <br />required by written contract. General Liability policy shall be Primary and Non-contributory with any other insurance <br />in force for or which may be purchased by Additional Insured as required by written contract or agreement. Waiver of <br />Subrogation applies in favor of Additional Insured with respects to General Liability, Auto Liability and Workers <br />Compensation as required by written contract and as permitted by law. <br />CERTIFICATE HOLDER <br />CANCELLATION <br />SAMPLE <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 />ACORD 25 (2016/03) <br />© 1988-2016 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />SR ID: 17262094 BATCH: 996237 <br />
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