HomeMy WebLinkAboutKalifornia Pool General Liability CERTIFICATE OF LIABILITY INSURANCE
American Family Insurance Company ❑
American Family Mutual Insurance Company,S.I. if selection box is not checked.
6000 American Pky Madison,Wisconsin 53783-0001
Insured's Name and Address Agent's Name,Address and Phone Number(Agt./Dist.)
Kalifornia Pool&Spa James Miller Agency, Inc.
PO Box 1469 10650 COUNTY ROAD 81 STE 105
Maple Grove, MN 55311 MAPLE GROVE, MN 55369
(763)424-7933 (009/087)
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 listed below.
COVERAGES
This is to certify that 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.
POLICY DATE
TYPE OF INSURANCE POLICY NUMBER EFFECTIVE EXPIRATION LIMITS OF LIABILITY
(Mo,Day.Yr) (Mo,Day,Yr)
Homeowners/ Bodily Injury and Property Damage
Mobilehomeowners Liability Each Occurrence $ '000
Boatowners Liability Bodily Injury and Property Damage
Each Occurrence $ '000
Personal Umbrella Liability Bodily Injury and Property Damage
Each Occurrence $ '000
Farm Liability&Personal Liability
Farm/Ranch Liability Each Occurrence $ '000
Farm Employer's Liability
Each Occurrence $ '000
Statutory ......»»..
Workers Compensation and Each Accident $ '000
Employers Liability t Disease-Each Employee $ '000
Disease-Policy Limit $ '000
General Liability General Aggregate $ 4,000,000
❑x Commercial General Products-Completed Operations Aggregate $ 4,000,000
Liability(occurrence) 22-XD0659-24 12/22/2021 12/22/2022 Personal and Advertising Injury $ 2,000,000
❑ Each Occurrence $ 2,000,000
❑ Damage to Premises Rented to You $ 100,000
Medical Expense(Any One Person) $ 5,000
Each Occurrencett $ '000
Businessowners Liability Aggregatett $ '000
Liquor Liability Common Cause Limit $ '000
Aggregate Limit $ 000
Automobile Liability Bodily Injury-Each Person $ '000
❑ Any Auto
❑All Owned Autos Bodilylnjury-Each Accident $ 000
❑ Scheduled Autos Property Damage $ '000
❑ Hired Auto
❑ Nonowned Autos Bodily Injury and Property Damage Combined $ '000
El
Excess Liability
❑ Commercial Blanket Excess Each Occurrence/Aggregate $ '000
El
Other(Miscellaneous Coverages)
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES 1 RESTRICTIONS!SPECIAL ITEMS tThe individual or partners ❑Have
shown as insured elected to
be covered under this policy. ❑Have not
ttProducts-Completed Operations aggregate
is equal to each occurrence limit and is
included in policy aggregate.
CERTIFICATE HOLDER'S NAME AND ADDRESS CANCELLATION
❑ Should any of the above described policies be cancelled before the expiration date
thereof,the company will endeavor to mail`( days)written notice to the Certificate
Holder named,but failure to mail such notice shall impose no obligation or liability of any kind
upon the company, its agents or representatives. *10 days unless different number of days
shown.
❑x This certifies coverage on the date of issue only. The above described policies are
subject to cancellation in conformity with their terns and by the laws of the state of issue.
DATE ISSUED AUTHORIZED REPRESENTATIVE
03/22/2022 James T. Miller
U-201 Ed.5100 Stock No. 06668 Rev.7/02