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CERTIFICATE OF LIABILITY INSURANCE 7E(MM/DDNYYY) /23/2019 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 NAME: Matthew Cartier Cartier Agency, Inc. PHONE FAX 2631 W. Superior St A/C No Ext: (218) 727-5992 A/C,No: E-MAIL ADDRESS: ahess@caduluth.com Duluth MN 55816 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:western National 15377 INSURED (651) 481-1190 INSURERB:American Interstate Insurance 31895 Rink-Tec International Inc. INSURER C INSURERD: 3485 Willow Lake Blvd Suite #500 Vadnais Heights MN 55110 INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: Cert ID 4808 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE IX I OCCUR CPP0020756 18 02/01/2019 02/01/2020 IREMSESOEaoccurrDence $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO - POLICY PRO JECT ❑LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ A ANY AUTO CPP0020736 18 02/01/2019 02/01/2020 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY A X UMBRELLA LAB X OCCUR UMB0011474 18 02/01/2019 02/01/2020 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LAB CLAIMS -MADE DED X RETENTION$ 10,000 Pers/Adv Injury $ 5,000,000 B TION AND EMPLOYERS' LIABILITY ANDEMPWORKERS YERS'LSAILIT Y/N AVWCMN2767402019 02/Ol/2019 02/Ol/2020 X STATUTE OERH ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A E.L. DISEASE -EA EMPLOYEE $ 11000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Inland Marine CPP0020756 18 02/01/2019 02/01/2020Rented/Leased Equipment $ 150,000 A Property - Commercial CPP0020756 18 02/01/2019 02/01/2020 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project Name: Elk River Ice Arena and Lion John Weicht Park Facilities Stored Materials: Rink 1 and 2 Mains Piping and Insulation, Rink Chairs, Vapor Barrier and Expansion in total value of $230,000 The following entity's are included as additional insured with a waiver of subrogation in their favor: City of Elk River 13065 Orono Parkway NW Elk River, MN 55330 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. RJM Construction 830 Boone Ave North AUTHORIZED REPRESENTATIVE Golden Valley MN 55427 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 2