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, ACORD' ��T�F1�A"T� ��' ��,�E"��ITl� �N��1�.A�� ' ; :; 02/13/19 8' ::::::.;....::.;.:..::::::::.. .::.::..:::: __ _ .... ... .. ... ::: . . :::. :..:. PRODUCER �612)448-3800 F� (612)448-3304 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE a s u a 1 t y A s s u r a n c e I n c HQLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 101 W e s t T h i r d S t r e e t ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Box 38 COMPANIESAFFORDINGCOVERAGE _ . __._.. ___....... ....._ _.._... ...___ ... .. . __. Chaska, MN 55318 COMPANY Western National Attn: Lynn Erickson Ext: ' p` _.__ .......... _.... ......... _.._......._......_ _......... ................._... .. .................._................ __. _.... __.. __....... INSURED COMPANY Daniel R. Anderson g 10305 County Road 17 Se i............_ ......__........ _... .. ... .......... ._...___._..... .. ..._..........___.......... ... ' COMPANY Delano, MN 55328 C ' . _......_ _ ...._... ..._._.... ._.......... _ . __ _. . I COMPANY D ;.:::>:::.<::::.: _ _. .. :.::..:: .::.. . .. G01iERAGES:<:;::>:::.•''?`:::. . ;::>:::;:;:;;. ;:>:>:>;..:•. ,.;:;::: _ ;:,. >:... 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, EXC�USIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _.. ._. . .............._ .... . .._...... _........ ........._.. ......._ .._ ,......._........._.. _.. _ . ........___ _......._.........___. _.__....... _ ... CO 7ypE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE 'POLICY EXPIRATION: LIMITS LTR DATE(MM/DDlYY) DATE(MM/DD/YY) : GENERAL LIABI.ITY '. ; ; GENERAI AGGREGATE � 5 3 O O,0 0 0 . . �.: �....................................................................................... X COMMERCIAL GENERAL IIABILITY ' PRODUCTS-COMP/OP AGG $ 3 O O,O O O ::....._ , _........_... . ..._.........._....................._.._............. ':CLAIMS MADE : X OCCUR i ; PERSONAL&ADV INJURY ' $ 3 O O,O 0 O A `>:<i<iz......: ; $P7483 04/09/1997 ' 04/09/1998 .................................................................................... OWNER'S&CONTRACTOR'S PROT; EACH OCCURRENCE S 3 O O,O O O _.._........_......._....__... i ! FIRE DAMAGE(Any one fire) 3 5 0,0 0 0 .......... .......................... ... ............................................. MED EXP(Any one personl $ 5�0 0 0 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ' $ ANY AUTO ' ALL OWNED AUTOS ? ' BODILY INJURY � SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNEDAUTOS ` ; (Peraccident) ' $ : _......:..... ...._. .. __ ....................................... i i ' i PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ' $ _............................:::::::::::::::::::::::::::::::::::: ANY AUTO OTHER THAN AUTO ONLY: _... ;,: ,.,:,,:::.:.. EACH ACCIDENT $ ................................... . .............................................................................. AGGREGATE $ EXCESS LIABILITY i EACH OCCURRENCE $ .............................................................................. UMBRELLAFORM ; AGGREGATE ' $ _.._......._._.. _.................: ............... ._... ....__.... OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND ' ;TORY LIMITS: ER :;< EMPLOYERS'LIABILITY ;;;;;;;; ; . ,.::.:.::.::,::.,:,.:::,:.:::.,.:,: _....__. . .......:....__...... El FACH ACC�DENT 5 THE PROPRIETOW ..._................... ............................ I INCL EL DISEASE-POIICY LIMIT $ PARTNERS/EXECUTIVE I...._ , . .._............_................_................._...... ....__. _ OFFICERS ARE: EXCL: EL DISEASE-EA EMPLOYEE S OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS ...:..: ..:. ::.:::: .�::.:::::::i�.. .:�.::::::.:�. : -. � .:..::.. . �':i�.:...:;:E:i i�;;:i>::i.. G�tTiEIiG11TE FtQ£:[)�R ;;:::>;;;::...:............. ,> :. �AN��.i,A..... ,: ;::::>:;.,.;:: ::::::::::::.:::::::::::::::::::::::::::.::::.::::::::::.:::.::::::::::::::::::::::::::::::::::::::,:::::::::,:::::::::::::::::::._::::::::::::::..::::.::::::::::::::::._::::::.:::::::::::::::.:::::::::.::::::::::::::::.::::::::::::.. ................. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL �LV DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, City of Orono A t t n' S t e V e BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 2 7 5 0 K e 1 1 e y P d�k W d y OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. 0 r o n o, M N 5 5 3 5 6 AUTHORI REPRESE ATIVE � �MVw� aco��s��as� _ __ __ , , ; _ maec��cx��c�Tic�x�s.: