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<br />ACC " CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DDIYYYY)
<br />8/17/2022
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME: Allle Darling
<br />CSDZ, LLC
<br />225 South Sixth Street, Suite 1900
<br />PHONE FAX
<br />AIC No Ext : 612-322-6041 A/C No),
<br />ADDRESS: adarling@csdz.com
<br />Minneapolis MN 55402
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: Western National Mutual Insurance Co
<br />15377
<br />INSURED BURCONPC6
<br />INSURER B : Travelers Property Casualty Co. America
<br />25674
<br />Burschville Construction, Inc.
<br />PO Box 65
<br />INSURER C :
<br />INSURER D
<br />Hanover, MN 55341
<br />INSURER E
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: 1274843320 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DDIYYYY
<br />POLICY EXP
<br />MM/DDIYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CPPOO17461
<br />5/1/2022
<br />5/1/2023
<br />EACH OCCURRENCE
<br />$1,000,000
<br />Fv�
<br />CLAIMS -MADE OCCUR
<br />DAMAGE TO TED
<br />PREMISES('a cicur ence)$
<br />a occurrence)
<br />100,000
<br />X
<br />MED EXP (Any one person)
<br />$ 5,000
<br />Contr Liab Per
<br />X
<br />Policy Form/XCU
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />POLICY jE LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />CPP0017361
<br />5/1/2022
<br />5/1/2023
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />PROPERTYDAMAGE
<br />PeraccidentX
<br />$
<br />NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />HIRED LXX
<br />Hired Auto Phys Dmg
<br />$ 50,000
<br />Comp:$500 Coll: $500
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />UMB0010999
<br />5/1/2022
<br />5/1/2023
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED X RETENTION $ In nnn
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />WCV0010935
<br />5/1/2022
<br />5/1/2023
<br />X PER OTH-
<br />STATUTE ER
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />NIA
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />B
<br />Instl Fltr - Completed Value
<br />6603H707386
<br />5/1/2022
<br />5/1/2023
<br />Deductible: $2,500
<br />$750,000
<br />Leased or Rented Equip/ACV
<br />Deductible: $1,000
<br />$500,000 Per Item
<br />Sched Owned Equipment/ACV
<br />Deductible: $1,000
<br />See Below
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Lino Lakes - Belland Farms
<br />Additional Insured only if required by written contract with respect to General Liability, Automobile Liability and Umbrella/Excess Liability applies on a primary
<br />basis and the insurance of the additional insured shall be non-contributory:
<br />Rehbein Properties
<br />City of Lino Lakes
<br />WSB & Assoc.
<br />Carlson McCain, Inc.
<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 />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Rehbein Properties
<br />76254 24th Avenue N
<br />MN 55038
<br />AUT ORIZEDREPRESENTAT�IVEHugo
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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