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�� OP ID: 1C <br /> A�oRo� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) <br /> 12/22/11 <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 be endorsed. If SUBROGATION IS WANED, subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement s. <br /> PRODUCER 763-746$�OO CONTACT ' <br /> RJF Minneapolis PHONE FAX <br /> 7225 Northland Dr N#300 ac No: <br /> MinneaPolis, MN 55428 ' E-mAi� <br /> House ACCOU11tS PRODUCER M I KI LAN <br /> INSURER S AFFORDING COVERAGE NAIC# <br /> INSURED Mikie'sLandscaping INSURERA:ACUIt Insurance 14184 <br /> Mike Bartknecht INSURER B: <br /> 11039 County Rd. 16,SE <br /> Watertown,M N 55388 INSURER C: <br /> INSURER D: <br /> INSURER E: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THiS IS TO CERTIFY THAT THE?OLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED PvAMEu Ao3Vc FOR THE PuLiCY PEF2i0� <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 TYPE OF INSURANCE ADDL SUBR pOLICY NU BER POLICY EFF POLICY EXP LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ ��OOO�OO <br /> A X COMMERCIAL GENERAL LIABILITY L38140 04/15111 04/15N2 pREMISES Ea occurrence S 250��� <br /> CLAIMS-MADE a OCCUR MED EXP(Any one perean) $ �0��� <br /> PERSONAL&ADV INJURY $ N� <br /> GENERALAGGREGATE $ $,OOO,OO <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/0P AGG $ $�OOO�OO <br /> POLIC`F PRO- LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ��OOO�OO <br /> (Ea accident) <br /> l4 X ANY AUTO L3S�4O 04/15/11 04/15/12 BODILY INJURY(Per person) $ <br /> ALL OWNED AUTOS BODILY INJURY(Per accident) $ <br /> SCHEDULED AUTOS <br /> PROPERTY DAMAGE $ <br /> HIRED AUTOS (Per accident) <br /> NON-OWNED AUTOS $ <br /> $ <br /> UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ ��OOO�OO <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> A L38140 04/15N 1 04/15N2 <br /> DEDUCTIBLE S <br /> X REfENTION O $ <br /> WORKERSCOMPENSATION WCSTATU- OTH- <br /> AND EMPLOYER�LIAEILt'Y TORY.LIMITS ER..__.________�,__. <br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE Y� L38140 O4/'IS/'I'I O4I'IS/'IY E.L.EACH ACCIDENT $ SOO,OO <br /> OFFICERlMEMBER EXCLUDED? N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,0� <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ SOO�OO <br /> q Property L38140 04/15/11 04/15/12 Equip 10,00 <br /> ded <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 707,Additional Remarks Schedule,if more spaee is required) <br /> Certificate holder is provided evidence of coverage. <br /> Fax: 952-249-4625 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Clty Of Of0�0 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> For Demo:3572 Livingstone Ave <br /> Lyle Oman AUTHORI2EDREPRESENTATIVE <br /> PO Box 66 � � <br /> Crystal Bay, MN 55323 <br /> O 1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2009/08) The ACORD name and logo are registered marks of ACORD <br />