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Roy COL.tif i AUG -3 -2014 23:03 FROM:THOMAS FIERST INS 6517301622 TO:4024264195 P.2/2 DATE(MM)0D1YYYY) CERTIFICATE OF LIABILITY INSURANCE 8/4/2014 THIS GERTIFIGATE IS ISSUED AS A MATTER OF INFORMATION ONLY A CONFERS NO RIGHTS UPON THE CERTIACATE HOLDER. THIS CERTIPICATE D OE S NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POb.IC198 BELOW. T HIS CIERTIFICATE OF INSURANCE DOES NOT CONSTITUTE, A CONTRACT 00WEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CER TIFICATE HOLDER, IMPORTANT; If the certificate holder Is an ADDITIONAL INSURED, the policy(in) must be endorsed. If SUBROGATION IS WAIVED, subJect to tho terms and condition$ Of the p0114y, 0"In policies may require an endorsement. A statemept on this co rtlfle ate Gods not confer rights to the certificate holder In lieu of touch enderoement(s), PRODUCER NAME: THOMAS FIERST INSURANCE : (651 )'738 - 03,07 " A/0Na-( 10150 City Walk Or Svc tw A2 ADDRESS: tam@ f"rStCh"00.90M Woodbury, MN 55129 IN AMPORDING COVCRAGA wJes INSURER A , WILSON MUTUAL INSURED ROY ROGERS REMODELING INC INSURER B: INSURER C. 4056 WHIT B34R AVE INSURERS w' BL , HN 55115 INSURER E. _....... ,— INSURr_R F COVERAGES CERTIFICATE NULIBER; REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE B55N ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INIaICATEt7. NO'I'WI I HS'(ANUING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR QTHER DOCUMtiN I' WITH RESPECT TO WHICH THIS CERTIFICATE. MAY SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I$ SU$jFCT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I LTR TYPE OF INSURANCE W ert POLICY NUMBER MM1DDffYYY MMIPDIYYYt' LIMITS GENERAL LIABILITY EACH OCCURRFNOF 6 1 X COMMERCIAL GENERAL LIABILITY AptMI$C$ Ca occurrence S 300,000 CLAIMS-MADE Fx_ 1 oRCUR M00 FXP (Any one pensdn) $ 10, 000 A 3200896140 3 , 2 - 19 -13 : 12-1 B" 14 PoRSONALaAnVINJURY $ 1,000,000 GENERAL AGORCOA s 2, 00 0,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP10F AGO s 2 POLICY PR T F LOG $ AUTOMOCILG LIABILITY Ea accident)B ANYAUTO BODILY INJURY (Per person) e ALL OWNED SCHEDULED UOUILY INJURY (Pe, accident) S AUTOS AUTOS _ HIRED AUTOS AUTOSWNEA Per accident $ S UMBRGLLA LIA(# OCCUR EACH OCCURRENCE EXCESS UAS CLAimg - MAD E AGGREGATE S Off} RETENTIONS S WORKERS COMPENSATION T RYLIMIT AND EMPLOYERS' LIABILITY ANY FRQPRIETQRIpARTNER4MCUTIVE yrN EL. EACH ACCIDENT $ OFFICERIMEMpER �X4LL+G$G'� © NIA (Wrid ory In NR) E.L. DISEASE - EA EMPLOYS $ If y 86 deStribi under DESCRIPTION OF 4PEf KnONS below E.L. DISEASE - POLICY LIMIT S i gE$CRIPTION OF OPCRATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) I I CERTIFICATE HOLDER CAN CITY OF HLAIRE r NEEAhSKA SHOULD ANY OF THE ABOVE DESCRIBED POLIC Rrx CANCELLED BEFORE 218 SOUTH 16TH ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BLAIRE, NEEPAEKA 168008 AC WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT (Q 1908 ACpR©DORPORATION, All rights reserved. ACC1RI)25(2010/05) The ACORD name and logo are reg marks of ACORD