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DocuSign Envelope ID:E9187B35-0D19-4E96-883A-5B48B03DE760
<br /> DATE(MM/DD/YYYY)
<br /> A COR CERTIFICATE OF LIABILITY INSURANCE
<br /> ,,,,,.,.. - 2/2s/2o17
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER Phone: (9521944-2929 CONTACT Jane Doerfler
<br /> Fax: (952)944-3091 NAME`
<br /> Horizon Agency,Inc.
<br /> PHONE (952)914-7131 Ext): (952)914-7131 FAX
<br /> A No): (952)944-3091
<br /> 6500 City West Pkwy#100 ADDRess: janc@horizonagency.com
<br /> Eden Prairie,Minnesota 55344 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A: Federal Insurance Company 20281
<br /> INSURED INSURER B: Executive Risk Indemnity Inc. 35181
<br /> Waters and Company Incorporated INSURER C:
<br /> 380 Jackson Street#300 INSURER D
<br /> St.Paul,MN 55101
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:8207 REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W LIMITS
<br /> LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)
<br /> ✓ COMMERCIAL GENERAL LIABILITY 35342568 8/11/2016 8/11/2017 EACH OCCURRENCE $ 1,000,000
<br /> A DAMAGE TO RENTED 1,000,000
<br /> CLAIMS-MADE ✓ OCCUR PREMISES(Ea occurrence) $
<br /> MED EXP(Any one person) $ 10'000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> ✓ POLICY JECT PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY 73234006 8/11/2016 8/11/2017 COMBINED SINGLE LIMIT $ 1,000,000
<br /> A (Ea accident)
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> ✓ HIRED ,/ NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY (Per accident)
<br /> $
<br /> ✓ UMBRELLA LIAB ✓ OCCUR 79764838 8/11/2016 8/11/2017 EACH OCCURRENCE $ 2,000,000
<br /> A EXCESS LIAB 2,000,000
<br /> CLAIMS-MADE AGGREGATE $
<br /> DED ✓ RETENTION$ 0 $
<br /> WORKERS COMPENSATION 71646620 8/11/2016 8/11/2017 ✓ STATUTE 00TH
<br /> A AND EMPLOYERS'LIABILITY
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000
<br /> OFFICER/MEMBER EXCLUDED? N N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000
<br /> If yes,describe under 500,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> B Errors&Omissions 82079210 1/14/2017 1/14/2018 Each Claim 2,000,000
<br /> $25,000 Deductible 2
<br /> Aaareeate 2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Holder's Nature of Interest:Certificate Holder
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 200 South Cameron Street
<br /> Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE
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<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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