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, , � <br /> DATE(MMIDDIYYYY) <br /> ACORD CERTIFICATE OF LIABILITY INSURANCE lo�i2�2oo9 <br /> PRODUCER (952) 935-5551 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> Gladwin Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 738 llth Avenue South AL7ER 7HE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Ho kins MN 55343- INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED INSURERA:WeSt@Y'ri National Mutual <br /> Pump and Meter Service INSURERB: <br /> 11303 EXC@1310Z' BIVC� INSURERC: <br /> INSURER D: <br /> Ho kins MN SS343— INSURERE: <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY <br /> REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, <br /> THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. <br /> AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR ADD'L POLICY EFFECTIVE POLICV EXPIRATION <br /> LTR INSRD TYFE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE MMIDDIYY LIMtTS <br /> A GENERALLIABILITY CPP0015252 03/O1/2009 03�01�2OZO EqCHOCCURRENCE 8 1�000�000 <br /> X COMMERCIAL GENERAL LIABILITY PREMISES�aEoccu�nce s 1 OO,OOO <br /> CLAIMS MADE �OCCUR � � � � MED EXP(M one person) S 5,000 <br /> PERSONAL&ADV INJURY S 1,OOO�OOO <br /> � � � � GENERAL AGGREGATE S 2,OOO,OOO <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPlOP AGG s 2�OOO,OOO <br /> POLICY X JEC�T LOC � � � � <br /> A AUTOMOBIIELIABILITY CPP0015156 03/O1/2009 03�01/2OlO COMBINEDSINGLELIMIT <br /> X ANY AUTO (Ea accident) s 1,000,000 <br /> ALL OWNED AUTOS � � � � BODILY INJURY <br /> SCHEDULED AUTOS (Per person) $ <br /> HIRED AUTOS � � � � BODILV INJURY <br /> N01�FOWNED AUTOS (Per aaident) $ <br /> � � � � PROPERTYDAMAGE <br /> (Per aaident) $ <br /> GARAGELIABILITY AUTOONLY-EAACCIDENT E <br /> ANY AUTO � � � � OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> A EXCESSNMBRELLALIABILITY UMB0010691 03/O1/2009 �3�01�2�10 EqCHOCCURRENCE S 4�0�0��0� <br /> X OCCUR �CLAIMS MADE AGGREGATE S 4,OOO,OOO <br /> S <br /> DEDUCTIBLE � � � � g <br /> X RETENTION $10,000 8 <br /> A WORKERSCOMPENSATIONAND WCV0010629 O3/O1/2009 O3/01�2O10 X TORYLIMITS �ETR <br /> EMPIOYERS'LIABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 8 SOO�OOO <br /> OFFICER/MEMBER EXCLUDED? � � � � E.L.DISEASE-EA EMPLOYEE S 5OO,OOO <br /> It yes,describe under <br /> SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT E 500,OOO <br /> OTHER � � / / <br /> � � � � <br /> � � � � <br /> DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROV�SIONS <br /> CERTIFICATE HOLDER CANCELLATION <br /> ( ) — (952) 249-4616 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br /> 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOIDER NAMED TO THE LEFT,BUT <br /> C1 t17 OE� O2'OIlO FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE <br /> INSURER,ITS AGENTS OR REPRESENTATIVES. <br /> P.O. BOX 6 6 AUTHORIZED REPRESENTATIVE <br /> �:r� .�—��--- <br /> C stal Ba NID1 55323- <br /> ACORD 25(2001/08) O ACORD CORPORATION 1988 <br /> ����IN$025(0108)DS ELECTRONIC LASER FORMS,INC.-(800)327-0545 Page 1 ot 2 <br />