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Disclosures and Assurances The City of Lino Lakes can be assured that Brian Bourassa, as the signer of this proposal, has the authority to make the representations presented. WSB & Associates. Inc. ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMDOIYYYY) 11/16/2010 PRODUCER 952.893.1933 FAX 952.893.1819 H. Robert Anderson & Assoc., Inc. 4600 West 77th Street Suite 105 Edina, MN 55435 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED WSB & Associates, Inc. 701 Xenia Avenue South Suite 300 Minneapolis, MN 55416 1 INSURER A The Travelers Indemnity Company INSUPERB The Travelers Indemity Co. of rica NSURERC Hartford Ins. Co. of the Midwest INSURER XL Specialty Insurance Co. INSURER E. COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR AORL INSRO TYPE OF INSURANCE POLICY NUMBER DAATTE RisarDDIYYYYL DATE (jJMIDEVYYYY) UNITS GENERAL UA JTY X i COMMERCIAL GENERAL LIABILITY 680 8388R315 10/01/2010' 10/01/2011 EACHOCCURRENCE 'S 1,000,000 PREMISES (Ea mamma) $ 1,000,000 1 l CLAMS MADE X OCCUR ,-- MED EXP (Any one Nunn) S 10,000 PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LMIT APPLIES PER. 7 POLICY l E a F. LOC PRODUCTS - COMP/OP AGG $ 2,000,000 A AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS BA 8391R701 10/01/2010 10/01/2011 coMBWEo SINGLE LINT (Ea ac naM) S 1,000,000 BODILY INJURY (INI Paean) $ BODILY INJURY I (Pa anode.) $ S PROPERTY DAMAGE (Pat ancient) GARAGE LIAeUTY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY AGG $ $ B U EXCESSI UMBRELLA X I OCCUR J CLAMS MADE CUP 8404R215 10/01/2010 10/01/2011 EACHOCCURRENCE 5,000,000 AGGREGATE $ 5,000,000 S DEDUCTIBLE RETENTION S $ $ C WORKERS COMPENSATION 41WEC PL9374 10/01/2010 10/01/2011 X ;TORY LIiiITSI 'UER AND EMPLOYERS' IJABRRY Y I N ANY PROPRIETORIPURTNERIEXECUTNE[] OFFICER/MEMBER EXCLUDEDT I� (Mandatory in NH) unit OesaiOV *A PROVISIONS INN E L EACH ACCIDENT S 1,000,000 E.1 DISEASE - EA EMPLOYEE $ 1,000,000 E L. DISEASE - POLICY LIMIT S 1, 000,000 oTH essional Liability D Prof DPR9689491', 10/01/2010 10/01/2011 Each Claim/ 55,000,000 Annual Aggregate 510,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS This certificate or memorandum of insurance does not affirmatively or negatively amend, extend, or alter the coverages afforded by the insurance policies. *10 days notice for cancellation if reason is for non - payment of premium. CERTIFICATE HOLDER CANCELLATION ISSUED FOR INFORMATIONAL SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 305 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIAOUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. BEING PURPOSES ONLY. AU RE SENTATNE TNORe _ //� L L_ L, _ _. r ACORD 25 (2009/01) 01988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Disclosures and Assurances S