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BOLTO-1 OP ID: BW ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE(M 04/2288D/YYYY) 114 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 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). CONTACT PRODUCER 507-388-2010 NAME: Brown&Brown of MN/Mkto 530 W Pleasant St 507-388-5492 HOE NNo EXt: (A/C,No): Mankato,MN 56001 E-MAIL Tim Schwartz ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Westfield Insurance Company 24112 INSURED Bolton and Menk, Inc. INSURER B:Westfield National Insurance 24120 1960 Premier Dr Mankato, MN 56001 INSURER C7 INSURER D: INSURER E: INSURER 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 TYPE OF INSURANCE DDL UBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 • X COMMERCIAL GENERAL LIABILITY CMM 3 406 737 07/01/13 07/01/14 DAMAGE TO RENTED 1 000 000 PREMISES Ea occurrence $ e e CLAIMS-MADE J OCCUR MED EXP(Any one person) $ 10,000 • X XCU Coverage BLKT CONTRACTUAL LIAB 07/01/13 07/01/14 PERSONAL&ADV INJURY $ 1,000,000 • X Blkt Addl Insured &BLKT WAIVER SUBROGATION 07/01113 07/01/14 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 RO POLICY X JJ CT LOC Emp Ben. $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ • X ANY AUTO CMM 3 406 737 07/01/13 07/01/14 BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X Blkt Waive of Subro $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 • X EXCESS LIAB CLAIMS-MADE CMM 3 406 737 07/01/13 07/01/14 AGGREGATE $ 5,000,000 DED X RETENTION$ -0- $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE F N WCP 5 080 987 07/01/13 07/01/14 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) BLANKET WAIVER OF SU BR E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 B Professional Liab AFE 11 401 97 18 12/31/13 12/31/14 Claim 5,000,000 Errors&Ommission RETROACTIVE DATE 12/31/97 Aggregate 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION CITYELK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Elk River ACCORDANCE WITH THE POLICY PROVISIONS. Justin Femrite, P.E. City Engineer AUTHORIZED REPRESENTATIVE E Orono Parkway Elk River, 0 ,� Ik River, MN 55330 �-� "d' ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD