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ACC) CERTIFICATE OF LIABILITY INSURANCER�ATEI MIOD"YYY) L-� 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 endorsements . PRODUCER Britton Gallagher One Cleveland Center, Floor 30 1375 East 9th Street E, T NAME: PHONE rFAX 216-658-Z Arc NR: _ E-MAIL ADDRESS: Cleveland OH 44114 INSURER(S) AFFORDING COVERAGE NAICN INSURERA:Company INSURER S;Everesf IndomnityInsurance C GENERAL LIABILITY INSURED INSURER C:EVereStNaJiQ0aIInsuranceC Pyrotechnic Display Inc. 8450 W. St. Francis Road Frankfort IL 60423 INSURER D: N WC Assigned isk Plan INSURER E: INSURER F: AMP N PREMISES Ea or<ua ce1 5500,000 COVERAGES CERTIFICATE NUMBER: 789003136 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, INS R LTR TYPE OF INSURANCE ADDL SUER N R'.WO POLICY EFF POLICY NUMBER (MMIDDNYYYI POLICY up fMMIDDNYYYILIMITS B GENERAL LIABILITY S18ML00006-151 9/30/2015 9/30/2016 EACH OCCURRENCE 51,000.000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE IT]OCCUR AMP N PREMISES Ea or<ua ce1 5500,000 MED EXP (Any one person) 5 PERSONAL 8 AOV INJURY 51,000,000 GENERAL AGGREGATE 52.000,000 i PRODUCTS -COMNOP AGO 52.000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY [X�J PRO- LjECT LOC I5 C AUTOMOBILE LIABILITY 618CA00006-151 9/30/2015 9/30/2016 Eaaccd.ra 31,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per acc,dent S 1 % X NON -OWNED HIRED At AUTOS PROPERTY DAMAGE Perarcidenl S $ A UMBRELLA LIAR X OCCUR 'EAU733983 119/30/2015 9/30/2016 EACH OCCURRENCE $4,000.000 X EXCESS UAB CLAIMS -MADE AGGREGATE S4000,000 DED I I RETENTIONSS 19130/2015 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY VIN MNAROOODO19716-7(MN) 9/30/2016 X VJC STATU- OTH- EL EACH ACCIDENT $1,000,000 • ANY PROPRIETORMARTNERIEXECUTIVE OPRCER/MEMBER EXCLUDED' NIA DISEASE-EAEMPLOYE $1,000,000 ((Mandatory in NH) DESCRI witansTION ostler DESCRIPTION OF OPERATIONS below IEL EL DISEASE - POLICY LIMIT 51.000000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AHach ACORD 101, Additional Remarks Schedule, if more space is inquired) Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. DISPLAY DATE: August 13, 2016 LOCATION: City of Hugo, Minnesota ADDITIONAL INSURED: City of Hugo, Minnesota; Wilson Tool International Wilson Tool International Attn: Mr. Wally Zschokke 4902 Evergreen PI North Branch MN 55056 ACURU 25 (201011)5) 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 1988-2010 ACORD 1 he ACORD name and logo are registered marks of ACORD reserved.