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� ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY)
<br />� 02/01/2022
<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(sl. PRODUCER CONTA1,T Sandi Wong NAME: StateFann David Schiminsky, Agent r4�)?N,,fn e_,, 651-774-8671 Irie� Nol: 651-415-1284
<br />2097 County Road D Suite B �ss: sandi.wong.e94h@statefarm.com
<br />Maplewood, MN 55109 INSURERISl AFFORDING COVERAGE NAIC#
<br />INSURER A: State Farm Fire and Casualty Company 25143 INSURED INSURER 8: State Farm Mutual Automobile Insurance Company 25178
<br />Houck Motorcoach ADV INC. INSURERC:
<br />1025 Tornlyn Ave Suite 100 INSURER D:
<br />Shoreview, MN 55128 INSURER E:
<br />INSURERF:
<br />COVERAGES CERTIFICATE NUMBER· 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 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. l fSR TR
<br />A
<br />B
<br />A
<br />A
<br />TYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY =i CLAIMS-MADE IZl OCCUR
<br />-
<br />GEN'L AGGREGATE LIMIT APPLIES PER: ZJ □PRO-POLICY JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO t--OWNED AUTOS ONLY
<br />OLoc
<br />AUTOS -HIRED IZ SCHEDULED NON-OWNED -AUTOS ONLY AUTOS ONLY
<br />� UMBRELLA LIAB � OCCUR excess LIAB CLAIMS-MADE OED I I RETENTION$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIET0R/PARTNER/EXECVTIVE � OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, desclibe under DESCRIPTION OF OPERATIONS below
<br />ADDL SuBR ouon lun,n
<br />y N
<br />y N
<br />N/A N
<br />POLICY NUMBER P0LICYEFF IMMI0DIYYYYI ,�glt,%Tv%, LIMITS EACH OCCURRENCE s 5,000,000 Ul'.MAGE TO RENTED s 300,000 ..Efil:�ES /Ea occurrence' MED EXP (Any one oerson) s 5,000
<br />93-EE-K459-0 03/01/2022 03/01/2023 PERSONAL & ADV INJURY $ 5,000,000 GENERAL AGGREGATE s 10,000,000 PRODUCTS • COMP/OP AGG $ 10,000,000
<br />line 2 includes fire liab $
<br />163-8623-F22-23K 12/22/2021 06/22/2022 COMBINED SINGLE LIMIT $ tEa accidenll BODILY INJURY (Per person) $ 2,000,000 BODILY INJURY (Per accident) $ 2,000,000 PROPERTY DAMAGE s 1,000,000 /Per accident\
<br />EACH OCCURRENCE s 5,000,000
<br />93-BG-C698-9 07/29/2021 07/29/2022 AGGREGATE s 5,000,000
<br />$ Xl�ffTUTE I I OTH-ER
<br />$ 1,000,000 93-MD-E331-8 02/09/2022 02/09/2023 E.L EACH ACCIDENT
<br />1,000,000 E.L. DISEASE • EA EMPLOYEE $ E.L. DISEASE • POLICY LIMIT s 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If mare space is required)
<br />CERTIFICATE HOLDER
<br />ACORD 25 {2016/03)
<br />CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
<br />© 1988-2015 ACORD CORPORATION All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />1 1486 132849.12 03-16-2016
<br />DocuSign Envelope ID: D69C08A6-A69B-49E8-9647-1D921DFCD3DE
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