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�� OP ID: MS '`��R�� CERTIFICATE OF LIABILITY INSURANCE DATO7IOZI�2 Y� 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 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 763-295-2614 CONTACT Foster,Carlson&White Agency PHONE Fnx 20o W edwy Po Box 188 763-295-3010 l�c,No,Ex��:-------- --_-_--_--- - - __ �i �nic,No�:_ Monticello,MN 55362 E-^^Ai� Mark White ADDRESS:__ _____ - PRODUCER LEGAC-3 CUSTOMER ID#: INSURER(S)AfFORDING COVERAGE NAIC# - - � - - - - - � -- - � � - --- - --- - - - - - - ----------- wsuReo Legacy Mechanical Services, wsuReRn:State Auto Insurance Companies 25127 LLC iNsuRER B:RAM Mutual Insurance Com an 16330 1236 Edmonson Ave NE P y--- - Monticello, MN 55362 iNsuaeR c: INSURER D: � INSURER E: � INSURER F: � COVERAGES CERTIFICATE NUMBER: 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� 7ypE OF INSURANCE DOL UBR', pOLICY NUMBER �MM/DY/YYYY MM ODIYYYY LIMITS LTR � GENERAL LIABILITY i li �, � EACH OCCURRENCE 5 'I�OOO�OOO � DAMAGE T�RENTED -� - - A '� X � COMMERCIAL GENERAL LIABILITY � II BOP 2613875 li O6/10H 2 II 06/10/13 � pREMISES jEa_occurrence]___$ 300,�� - � ------- -- - - - - � I CLAIMS-MADE I_X�l OCCUR ', � �i �MED EXP(Any one person) $ . 5,00 �. � . PERSONAL&ADV INJURY $ 'I,OOO,OOO i � � � I �GENERALAGGREGATE $ Z,OOO,OOO h -- ' GEN'L AGGREGATE LIMIT APPLIES PER�. I PRODUCTS-COMP/OP AGG li $ � Z,OOO,OOO PRO- i_ . . � - - - � - � �� POLICY X � T � LOC i $ �,AUTOMOBILE LIABILITY I I i I COMBWED SINGLE LIMIT I � '��OOO,OOO , i i i '� li (Ea accident) ! A � X ANY AUTO BAP 2327914 06/27/12 ', Os/27/13 , i - I i i BODILY INJURY(Per person) $ � ALL OWNED AUTOS I � � � - �� --�-- �--------- - - - - BODILY INJURY(Peraccident) $ I SCHEDULED AUTOS II i I ---- � � � ---------� -- - - PROPERTY DAMAGE $ C . HIREDAUTOS (Peraccident) �I NON-OWNED AUTOS � $ � I -- ---------- ------ $-- - - - � - � UMBRELLA LIAB � i OCCUR EACH OCCURRENCE $ �- - � ---- � - --- . . _ -_ _ ! EXCESS LIAB � I !. CLAIMS-MADE AGGREGATE $ I- - - -- -------- I __ _ . _ __.- � - ------ i DEDUCTIBLE �I I i _ .. . . _ - $-_-_--_----_-- I � RETENTION $ ' $ I WORKERS COMPENSATION II I � � X WC STATU- OTH-� � AND EMPLOYERS'LIABILITY y�N �� , I I .__1TORY LIMITS_I__ I ER_�_____ ___ B I ANY PROPRIETOR/PARTNER/EXECUTIVE IWC 3OZZSO.00 I OBH O/'I Z �I 06/10/13 � E1.EACH ACCIDENT � $ 'I OO,OO I OFFICER/MEMBER EXCLUDED? �IIIN�A' � � i �- --- - � � � -1 - -- -- - - - - - - - (Mandatory in NH) � 'i i 'i E1.DISEASE=EA EMPLOYEEi 5 _ . 1��,�� If yes,describe under I ��. II i ! � � 5�0,�0 DESCRIPTION OF OPERATIONS below , E.L.DISEASE-POLICY LIMIT ' $ i �I li DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 107,Adtlitional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION CITYORO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI Of OfOf10 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ty ACCORDANCE WITH THE POLICY PROVISIONS. Orono, MN AUTHORIZED REPRESENTATIVE Mark White O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD