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HomeMy WebLinkAboutAuto insurance ' 1 DATE(MM/DD/YYYY) ACORO® CERTIFICATE OF LIABILITY INSURANCE 11/14/2022 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 have ADDITIONAL INSURED provisions or 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 Jamie Nabozny NAME: merican Family Insurance-Business Insurance 10650 COUNTY ROAD 81 STE 105 PHONE FAX MAPLE GROVE MN 55369 (A/C,No,Ext): 866 908-0626 A/C,No): (763)424-7933 E-MAIL jnabozny@amfam.com ADDRESS: service@amfambusinessinsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Midvale Indemnity Company 27138 INSURED INSURER B: Nickolas Olsen INSURER C: PO BOX 1469 Maple Grove MN 55311 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1671207357512 REVISION NUMBER: HIS 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 O WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT O ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDD MMIDD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE a OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) MED EXP(Any one person) PERSONAL$ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY PRO- OC PRODUCTS-COMP/OP AGG JECT OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO Y N CA00005557 01/13/2022 1/13/2023 BODILY INJURY(Per person) $1,000,000 OWNED X SCHEDULED BODILY INJURY $1,000,000 AUTOS ONLY AUTOS (Per accident) X HIRED X NON-OWNED PROPERTY DAMAGE $100,000 AUTOS ONLY AUTOS ONLY (Per accident) MBRELLA LIAB OCCUR EACH OCCURRENCE XCESS LIAB CLAIMS-MADE AGGREGATE DIED I I RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECU -TIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE If yes,describe under E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below PROFESSIONAL LIABILITY OCCURRENCE AGGREGATE DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Hayward Holdings INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 1 Hayward Industrial Dr ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Clemmons NC 27012 ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD