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WDWIPLA-01 Q E-1 IE-8
<br />CERTIFICATE OF LIABILITY INSURANCE DATE gMMIDDIYYYY)
<br />5'118/2023
<br />'THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT'S 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 Molder is an ADIMT11ONAL INSURED, the pohcy(Ies) unrest Leave ADDrIONAL. 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 sUrtement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsernent(s),
<br />PRODUCER
<br />CIA Insurance
<br />122 W Main St, PC Box 38
<br />Lime Springs, IA 52156
<br />566-2621
<br />p5laum,
<br />INSURER A CIriclinnati Spedafty Underwriters insurance Cornpany
<br />v 13037
<br />INSURED
<br />INSURERB:Ciricinnafilnsuran e,C rriparly,.__
<br />10677
<br />Midwest Physcapes Inc
<br />8632 Eagle Creek Cir
<br />. .....
<br />Savage, MN 55378
<br />COVERAGES CERTIF=TE NQMQER�
<br />REVISION NUMBER:
<br />THIS IS TO CERTff( THAT THE POLICIES OF INSURANCE LISTED BIELOW [HAVE BEEN ISSLIED TO THE INSURED NAMED ABOVE FOR THE
<br />POI ICY PERIOD
<br />INDICATED, NOTWTIHSTANDiNG ANY REQUIREMENT, TERM OR CONDI'DON OF ANY CONTRACT OR OTHER DOCUMENT VOTH RESPECT' 'TO WHICHTHIS
<br />CERT0CATE MAY BE ISSUED CIE MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL
<br />THE TERIMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .. ..... . ...........
<br />. .........
<br />'6414k __ , ........................ . .. . 46DL g6gi .. . ... ............... ... .......
<br />11R. TYPE OF INSURAINCE .INTLPOLICYNUMBER
<br />. . .......
<br />Fb LiC Y" EF, P, "P' 0, LiC Y _E X-P"" . .
<br />LIMITS
<br />. . ............... .
<br />A
<br />11000,000
<br />COMMERCIAL GENERAL JAMILITY
<br />EA H 0CCLJRRR4Cr
<br />$
<br />CLAW&MADE OCCUR X X CSU0209172
<br />5/20/2023 512012024 0AA14AGE TO NEE
<br />5 Ma_�"c
<br />1 0 0, 000
<br />6,000
<br />„.I'FIrDaEDVWALAAQVINJURY
<br />$
<br />1,000,000
<br />2,000,000
<br />AGGRE-GKI E UMIT APPLIFS PER:
<br />.,GEN1.
<br />P01-cypp Loc
<br />,bbii
<br />.... . . .
<br />. ..._
<br />mm
<br />B
<br />COMBINED SINGLE LIMIT
<br />1,00,000
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO CSU0209172
<br />6/1/2023 6/112024
<br />OWNED SCHEDULED
<br />AU_rdS ONLY AUTOS
<br />4
<br />X rqq N Q�
<br />X N Q, W �
<br />P
<br />(,rOPERTY DAMAGE
<br />AU S ONLY AIJT6
<br />. . . .....
<br />A UMBRELLA LIAB OCCUR
<br />...... .. ........... . ""' - - - --------- . .. . ... . ...... ", . ...................
<br />OCCURRENCE
<br />2,000, 000
<br />EXLAIMS MADE CSU0209172
<br />CESS LIAR C
<br />..EACH
<br />5/20/2023 5120/2024
<br />2,000,000
<br />D 2,500
<br />C WORKERS COMPENSATION
<br />Ti )TH-
<br />AND EMPLOYERS'LlAIDILl"Iry
<br />YIN X EWC 0654880
<br />61112023 61112024
<br />1,000,000
<br />ANY PROP R1 E I ORADART NERIEXEGUT� VE
<br />EXCI N/A
<br />YMBER
<br />W.Frl.Q� gRI'Mr _UDED?
<br />n NH)
<br />1,000,000
<br />If yes, describe under
<br />""0"00
<br />umr-
<br />�.,DE SCRIP1T1 . ...... - ------
<br />ON OF OPERATIONS I LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached N more space Is required)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATIODATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Midwest Playscapes, Inc ACCORDANCE WITH THE POLICY PROVISIONS.
<br />8632 Eagle Creek Circle
<br />Savage, MIN 55378
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 26 (2016103) 0 1988-2016 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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