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CERTIFICATE OF LIABILITY INSURANCE (215)ACORb4 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 7/26/2013 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 RJ Ahmann Company 7555 Market Place Drive Eden Prairie MN 55344 CONTACT NAME: Lisa Larson ia/cO °.Nr o. EMI:952- 947 -9700 (NC. No):952- 947 -9793 EMAIL ADDRESS:IIarson @rja.com LIMITS NAIC # INSURER(S) AFFORDING COVERAGE INSURER A American Safety Indemnity Co INSURED RAMJFL1 All Florida Ram Jack, LLC 16646 Scheer Blvd. Hudson FL 34667 INSURER B : 7/22/2013 ^ INSURER C : EACH OCCURRENCE INSURER D: DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER E : MED EXP (My one person) 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 OR 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 TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MMIDD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY ESL10006181302 , 2 7/22/2013 ^ 7/22/2014 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $50,000 MED EXP (My one person) $Excluded CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 GEN'L AGGREGATE POLICY X LIMIT APPLIES JFS:T PER: LOC Ded. $5,000 AUTOMOBILE _ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS r ..; j ' :r (LOMaEMS INGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ESU10006191302 7/22/2013 7/22/2014 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 $ DED X RETENT ON $ 0 WORKERS COMPENSATION AND EMPLOYERS' LIABIL TY Y / N ANY PROPRIETOR/PARTNER /EXECUTIVE f I OFFICER/MEMBER EXCLUDED? I (Mandatory In NH) I If yes, describe under DESCRIPTION OF OPERATIONS below N! A WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) NCELLATION City of Clearwater 100 Myrtle Avenue Clearwater MN 33756 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 ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC ©® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 7/26/2013 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 RJ Ahmann Company 7555 Market Place Drive Eden Prairie MN 55344 NAM`T Lisa Larson PHONE No, Ext):952- 947 -9700 E-MAIL SS:I larson@ rja. corn Wa No):952 -947 -9793 INSURER(S) AFFORDING COVERAGE NAIC INSURED All Florida Ram Jack, LLC 16646 Scheer Blvd. Hudson FL 34667 RAMJFL1 INSURER A:American Safety Indemnity Co INSURER B: INSURER 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 THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT T LL RMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MMIDDIYYYYL(MMIDD)YYYY) POLICY EXP LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ESL1 00061 81 302 \7/22/2013 722/2014 EAC CC E i $1„000 X PRA S ( RE PR I S {Ea oxurr e) $60,000 CLAIMS -MADE X OCCUR MED y on) $Exduded ADV INJJRY $1,000,000 GENII_ GENERAL AGGREGATE $2,000,000 AGGREGATE LIMIT APPLIES CT PER PRODUCTS - COMP /OP AGG $2,000,000 POLICY X ,ER I LOC Ded. $5,000 AUTOMOBLE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON - OWNED AUTOS COMBINED SINGLE LEMI I (Ea accideri) $ BODILY INJJRY (Per person) $ BODILY INJJRY (Per accident) $ PROPERTY DAMAGE (Per acadent) $ $ A UMBRELLA LIAB EXCESS LIAB X , CU E 1 6191302 (m . , I s r 7222 013 -z I J 72 2/2014 EACH OCCURRENCE $1,000,000 X C. M ADE AGGREGATE $1,000,000 DED X ENT ` $ WORKERS AN A • ( If D COM T10 AYE . PROPRIETO ICEREMEMB= EXCLU• •atory desai• n. -r OF OPERATIONS YIN N /A //**� .. -� ,,,, WC STATU- OTH- I TORY UNITS I ER E.L. EACH ACCIDENT $ CUTIVE II • E.L. DISEASE - EA.EMPLOYEE $ below E.L. DISEASE - POLICY LIMIT `�.i 1, DESCPoPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION City of Clearwater 100 Myrtle Avenue Clearwater MN 33756 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 ACORD 25 (2010/05) O 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD