IP #834 Part 2'W,
AC® ,� p
�...+� CERT LIABIL
DATE (MM /DD/YYYY)
1 06/24/2010
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
CONTACT
NAME Mary K Eberley
Liberty Insurance Agency
1560 Hart Blvd
PO Box 239
Monticello, MN 55362
A/C Ext: 763- 295 -8006 a No: 763- 295 -3679
ADD kmonse @rja.com
PRODUCER 1002110
CUSTOMER ID #:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURED
INSURER A: WESTFIELD GROUP
EACH OCCURRENCE
INSURER B;
A
NORD EXCAVATING INC
15265 209TH AVE NW
ELK RIVER, MN 55330
INSURER C:
TRA3318914
071'01/2010
07x`01'2011
DAMAGE TO RENTED
PREMISES Ea occurrence
INSURER D:
MED EXP (Any one person)
INSURER E:
PERSONAL &ADV INJURY
$ 1,000,000
INSURER F:
Contractual Liab
763-263-0501
COVERAGES CERTIFICATE NUMBER: REVISION NUMRFR-
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
LTR
I TYPE OF INSURANCE
ADDL
I NSR
SUBR
WVD
POLICY NUMBER
POLICY EFF
MM /DD/YYYY
POLICY EXP
MM /DD/YYYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
X
TRA3318914
071'01/2010
07x`01'2011
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 300, 000
MED EXP (Any one person)
$ 10,000
PERSONAL &ADV INJURY
$ 1,000,000
Contractual Liab
Ops of Subs Contingent
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OPAGG
$ 2,000,000
POLICY X PRO- LOC
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
TRA3318914
07/01/2010
07/011/2011
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
X
BODILY INJURY (Per person)
$
ALL OWNED AUTOS
BODILY INJURY (Per accident)
$
SCHEDULED AUTOS
HIRED AUTOS
X
PROPERTY DAMAGE
(Per accident)
$
X
NON -OWNED AUTOS
$
$
owned Private Pass. AutGa
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 5,000,
AGGREGATE
$ 5,
A
EXCESS LAB
CLAIMS -MADE
TRA3318914
07/01/2010
07.`01:'2011
DEDUCTIBLE
$
$
RETENTION $
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR /PARTNER /EXECUTIVE
OFFICER /MEMBER EXCLUDED? ❑N
(Mandatory in NH)
If yes, describe under
N/A
WCP3290145
07,'01/2010
07,01/2011
X WC STATU- OTH-
T RY ER
E L. EACH ACCIDENT
$ 500,000
E.L. DISEASE - EA EMPLOYEE
"-
$ 500, 000
E.L. DISEASE - POLICY LIMIT
$ 500,000
DESCRIPTION OF OPERATIONS below
A
Contractors Equipment
TRA3318914
071101/2010
0-/01/2011
Per Schedule $1000 ded
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
* This Certificate of insurance represents coverage as of the date of issuance and may or may not be in
compliance with any written contract.*
VGIS i 1r1VA 1 G nVLVCR GAIVGCLLA I IUN
CITY OF NEW HOPE
SHARI FRENCH / PARK & REC DIR.
4401 XYLON AVENUE NORTH
NEW HOPE_MN 55428
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
O 1988 -2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD