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HomeMy WebLinkAboutJaycees insurance binder TE(MM/DDIYYYY AC" CERTIFICATE OF LIABILITY INSURANCE rAS/2/20 6 ) 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 Julie Qllirin NAME: g Insurance By Design, LLC PHONE (952)808-7002 FA)( (952)808-7004 N Ex* AIC No 14041 Burnhaven Drive E-MAIL ulie @insurancedesi n.net ADDRESS: Q g Suite 100 INSURERS AFFORDING COVERAGE NAIC p Burnsville MN 55337 INSURERA:Scottsdale Insurance Company INSURED INSURER B Minnesota Jaycees, Inc INSURERC: Affiliated Local Chapters INSURER D: 5775 Wayzata Blvd, Spite 700 INSURERE: St. Louis Park MN 55416 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1591502146 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 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. INTRR TYPE OF INSURANCE ADDL SUER POLWVD POLICY NUMBER MM DDY� MMIDCDY� LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 RENTED A CLAIMS-MADE OCCUR DAMAGE (E.occrr 100 000 PREMISES Ea occurrence $ � X $2,500 DEDUCTIBLE X ACS0000232 9/22/2015 9/22/2016 MED EXP(Any one person) $ 2,500 X EXCL ATHLETIC PART PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 2,000,000 POLICY 7 1 PEC LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPidERTY DAMAGE $ AUTOS Per accent UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A LIQUOR LIABILITY ACS0000232 9/22/2015 9/22/2016 EACH OCCURRENCE $1,000,000 ANNUAL AGGREGATE $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Provides evidence of insurance for Lake Elmo Jaycees. Holder is listed as additional insured under the general liability policy for Huff n'Puff Days to be held 8/11/16 to 8/14/16. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Lake Elmo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 3800 Laverne Ave N ACCORDANCE WITH THE POLICY PROVISIONS. Lake Elmo, MN 55042 AUTHORIZED REPRESENTATIVE LuAnn Paulet/JAQ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 nnt4nn