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OS-02-'6; "��3� Gi ; 9522494616 ;7632950654 # 4/ 4 <br /> _�'�1 OP ID:MS <br /> ' � AC'ORO� CERTIFICATE OF LIAB�LI'TY INSURANCE DATE(M�lI�DM'Y1n <br /> �--r� os�oti2o�� <br /> THIS CERTIFICATE I$ I&SUEa pS A MATTER �F INFORMATION ONLY AND CONFERS NO RIGWT$ UPON THE CERTIFICATE HOLDER.TWI$ <br /> CERTIFICATE DOES NOT AFFIRMATNELY OR N�GATIVELY AMEND, FJCTEND dR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THI3 CERTIFICATE OF INSURANCE DOES NOT CQNSTITUTE A CON7t�ACT BETYVEEN THE 133UING INSl1RER(S), AUTHORIZED <br /> REPRESEPITATIVE 0!i PR�DUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: if tho cartlflcate holdar fs an ADDITtONAL INSUR�b,the policy{iea) must b*�ndarsad. If SUBROGATION IS WAIVED,subJect to <br /> the terms and conditiona of tba poficy,cartaln pollcl�s may rsqulrs an sndoraament. A atatemem on this caMificata does not conT�r rights to the <br /> c�rtlflaats holder In Ilau ef such endprbement S� <br /> PRODUCER NAM�• .�BKE OIIII er <br /> Foster Whita Agancy,Inc. pHoNE Froc <br /> 114 Wast 3rd StrAAt •759-295-26'14 �N,•7B3-29:f-3010 <br /> Monticello,MN 55892 oA p�Sa; olin e pgter-W�11tO.COti1 <br /> Jaka Olinger � ER LEGAC� <br /> cusraMeR�o e: <br /> INBURER(8)AGFORDINO COVERABE NAIC N <br /> n�sur�� �egacy e� en ca Servlces, IN811REqA Selective Insurance Co.ofAm �72572 <br /> LLC dba " <br /> Legacy Mechanlcal 8ervlces INSIIRER B: <br /> 114 Thomas Clrcle#706 IN9URER C: <br /> Mantieelld,MN 55362 INBUREfl D: <br /> INSURER E: <br /> INSUHEF F: <br /> COVERAGES CERTIFICATE NUMB�R: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE P�LIClES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREO NAMED ABOVE FOR THE POLICY FERIQD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM dR CON6ITION OF ANY CON7RACT OR OTHER DOCUMENT WITIi RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE 188UED OR MAY PERTAIN, THE IN9URANCE AFFOR�ED BY TkE POLICIE8 DE9CRIBED HEREIN IS $UBJEGT TO ALL Tt1E TERMS, <br /> EXCLUSIONS AND CONDITIOPIS OF SUCH P4LICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAfMS. <br /> � p TYPE OF 1NSURANCE POLtGY NUM6ER MM7D MM1� �1MIT$ <br /> 4ENERAI.uABItiTY FACMOCCURRENCE $ 'I,000,00 <br /> A X COMMERCIAL 6ENEPAL 61A9fLiTY SY�7GM1SZ O6I1 OIZO76 O6/1OIZOIT p�MIBES Ee oeeurronee S �OO,OO <br /> CLAIMSMADQ n OCCUR MED EXP An one eaon) S b���� <br /> ' PER80NALRADVIN,IURY j ��OOO�OO <br /> — I _.... <br /> � 4ENERALAQpREpATE 6 �i���r0� <br /> OEN'l AGGREGIATE LIMIT APPLIES PEFt i PftODUGT9-GOMP/OP A6G S Z�OOO�OO <br /> �POUCY' X P I.QC '� s <br /> AuroMael��UBluTY COMBINED 81NGLE LIMIT a 1,000,00 <br /> � {Ea acGOeiK) <br /> A X nnv nuro 52176462 05/10/2016 06h 01201T 80DI6Y INJURY(Pei D9�&on) S <br /> AlL OWNED AIJTOS "'"" <br /> BODILY INJURY(Per auident) $ <br /> SCMEOULEO AUTOB PROPERTY OAMAGE <br /> kIREDAUTOs (PERACCiDENT) S <br /> NON�OWN6D AUT0.S $ <br /> � <br /> UMBRELLALUIS OCGUR I �EACYI OCCVRRENCE $ <br /> � E7[CE99 LtA6 ��p,IMS-AA0.DE . !AGGREGATE S <br /> DEDUGT79LE �' �' � <br /> .—.. _ ....__.....__ <br /> RETFNTI ON � <br /> WORI�itS COMPENSATION X WC STATU- OTH- <br /> ANO EMPL0IERB'LIA91LhY <br /> A MIYPROPRfET'OflIPARTNEPlE7(ECUTIYETa WCg��Z�� 06/90/2016 06/10I2017 p,L.EACHpC,CIDHNT a 1,000,00 <br /> OFFIC�EUMEMOEREXCLU06�i Y p�A - <br /> (MantlaEoryirtNX) , E,L.DIBEASE-EAEMPLOYE $ �rQO��d�� <br /> N e,dattnlle u0U0f 1 000 000 <br /> o�SCRIFTION OF OPERATIONE bYIOW E.L.PISFJ+s�•POLICY LfMfT S � � <br /> ----- ---------------------------------- <br /> OEBCRfPTICW dp t1PrRA710N8/LOCAllf1M81 VEii1CLES(A!laeh ACOoiD 101,AOOHlonsl Mma�Ka BchrQula,I�maro rpaav fs roqulrad) <br /> CERTIFICATE HOLDER CANCELLATION <br /> CITYORQ <br /> BHOULD ANY OF TWE ABOVE DESCRIBEO POLICIES SE CANCELLED 9EFORE <br /> GI of Orono TFSE EXPIRATION DATE 7HER�OF, N(7TICE WILL g� bELIVEREb IN <br /> tY ACCbRDANCE WRH THE POLICY PROVISION&. <br /> Qrpno,MI� <br /> au�rnowg�aePr�serrranve <br /> Jeke Olinger <br /> M �1989-2Q09 ACORD CORPORATfON. All rlghts reserved. <br /> ACORD 25(2D09/09) The ACORD name and logo are reglstered marks of ACORD <br />