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<br />AC Ri CERTIFICATE OF LIABILITY INSURANCE
<br />( YYY
<br />70F,
<br />21/2Y20
<br />/21/2020
<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 />CONTACT
<br />NAME: Matthew Cartier
<br />Cartier Agency, Inc.
<br />PHONE FAX
<br />2631 W. Superior StWC,
<br />C No Ext: (218) 727-5992 WIC No:
<br />E-MAIL
<br />ADDRESS: ahess@caduluth.com
<br />Duluth MN 55816
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Western National
<br />15377
<br />INSURED (651) 481-1190
<br />INSURER B: American Interstate Insurance
<br />31895
<br />Rink-Tec International Inc.
<br />INSURER C :
<br />INSURERD:
<br />3485 Willow Lake Blvd
<br />Suite #500
<br />Vadnais Heights MN 55110
<br />INSURERE:
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: Cert ID 4808 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 />ADDL
<br />IN
<br />SUBD R
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DDNYYY
<br />POLICY EXP
<br />MM/DDNYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE � OCCUR
<br />CPP0020756 18
<br />02/01/2019
<br />02/01/2020
<br />AMAGE ToRENTE
<br />PREMSES E.occurence
<br />$ 1,000,000
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY JE� LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />CO MBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1, 000 , 000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />A
<br />ANY AUTO
<br />CPP0020736 18
<br />02/01/2019
<br />02/01/2020
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />L
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />UMB0011474 18
<br />02/01/2019
<br />02/01/2020
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED X RETENTION$ 10,000
<br />Pers/Adv Injury
<br />$ 5,000,000
<br />WORKERB AND
<br />EMPLOYERTIONS'
<br />AND EMPLOYERS' LIABILITY Y/N
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />AVWCMN2767402019
<br />02/01/2019
<br />02/01/2020
<br />X STATUTE EERPER H
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICER/MEMBEREXCLUDED? ❑
<br />(Mandatory in NH)
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />B
<br />Inland Marine
<br />CPP0020756 18
<br />02/01/2019
<br />02/01/2020
<br />Rented/Leased
<br />Equipment
<br />$
<br />150,000
<br />A
<br />Property - Commercial
<br />CPP0020756 18
<br />02/01/2019
<br />02/01/2020
<br />$
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Project Name: Elk River Ice Arena and Lion John Weicht Park Facilities
<br />Stored Materials: Compressor/Chiller/Pumps/Condenser - $349,742; MCC/Electrical - $120,000;
<br />Valves/Tanks/Fittings - $100,000
<br />The following entity's are included as additional insured with a waiver of subrogation in their
<br />favor:
<br />City of Elk River
<br />13065 Orono Parkway NW
<br />Elk River, MN 55330
<br />CERTIFICATE HOLDER CANCELLATION
<br />RJM Construction
<br />830 Boone Ave North
<br />Golden Valley MN 55427
<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 />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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