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MIDWPLA-01 DELSBERND CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 5/18/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT CIA Insurance PHONE 122 W Main St,PO Box 38 INC,No,Extl:(563)566�-2621 FAX No):(563)566-0906 Lime Springs,!A 52155D E-MAIL INSURERIS)AFFORDING COVERAGE ! NAIC# INSURER A;Cincinnati Specially Underwriters Insurance Company 13037 INSURED INSURER B:Cincinnati Insurance Company 10677 Midwest Playscapes Inc INSURER C:Cincinnati Casualty Company 128665 8632 Eagle Creek Cir I INSURER D: Savage,MN 55378 INSURER E: l _ lINSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR� POLICY EFF POLICY EXP LTR TYPE OF INSURANCE WV POLICY NUMBER IMMIDWYYYYi iMM!DDfYYYX1LIMITS A X COMMERCIAL GENERAL LIABILITY I 1 EACH OCCURRENCE 19000,000 CLAIMS-MADE T OCCUR X CSU0209172 5/20/2023 5/20/2024 DAMAGE TPREMISES G RENTED 1009000 MED EXP'Any one;)erson) $ 51000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE i$ 21000,000 POLICY 1XI jpo LOC PRODUCTS-COMPIOP AGG $ 2'000'000 OTHER: ___ 1$ B 'AUTOMOBILE LIABILITY COMBINED SINGLELIMIT $ '�,D00,000 X ANY AUTO CSU0209172 611/2023 5/1/2024 BODILY INJURY Per person i $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident, $ X HIRED X NONED PROPERTY DAMAGE 1 AUTOS ONLY AUTO ONLY er accident; $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 29000,000 EXCESS LIAB CLAIMS-MADE CSU0209172 5/20/2023 5/20/2024 AGGREGATE $ 200OO,000 DE D X RETENTION$ 29500. $ C WORKERS COMPENSATION PER ORTH- AND EMPLOYERS'LIABILITY Y/N x EWC 0654880 6/1/2023 6/1/2024 11000,000 ANY PROPRIETOR/PARTNER/EX ECUTIVE NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED. (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1 000 O00 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ ' ' DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Midwest Playscapes,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. i 8632 Eagle Creek Circle — Savage,MN 55378 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD