I-1 - House Moving Route, Sign Inventory, Insurance, Axle Rating

CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERNS 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 Maguire Agency 1970 Oakcrest Avenue, Suite 300 Roseville, MN 55113 CONTACT Melissa Munsterman NAME: PHONE (AC, No, Ext): (651) 635-2764 FAX (AC, No): (651) 638-9762 EMAIL: [email protected] ADDRESS: INSURER(S) AFFORDING COVERAGE INSURER A: Nova Casualty Company 42552 INSURER B: SFM 11347 INSURER C: INSURER D: INSURER E: INSURER F: INSURED Goodwin House Moving, Inc. 2964 Coppock Road Washington, IA 52353 COVERAGES CERTIFICATE NUMBER: 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 REMAIN, 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. <table> <tr> <th>INSR LTR</th> <th>TYPE OF INSURANCE</th> <th>ADD'L SUBS/INS'D WVD</th> <th>POLICY NUMBER</th> <th>POLICY EFF. (MM/DD/YYYY)</th> <th>POLICY EXP. (MM/DD/YYYY)</th> <th>LIMITS</th> </tr> <tr> <td>A</td> <td>COMMERCIAL GENERAL LIABILITY<br>CLAIMS-MADE X OCCUR</td> <td></td> <td>MSMML10000000</td> <td>1/1/2023</td> <td>1/1/2024</td> <td>EACH OCCURRENCE $1,000,000<br>DAMAGE TO RENTED PREMISES (Each occurrence) $100,000<br>MED EXP (Any one person) $5,000<br>PERSONAL & ADV INJURY $1,000,000<br>GENERAL AGGREGATE $2,000,000<br>PRODUCTS - COMP/POP AGG $2,000,000</td> </tr> <tr> <td>A</td> <td>AUTOMOBILE LIABILITY<br>ANY AUTO OWNER AUTOS ONLY X SCHEDULED AUTOS<br>X HIRED AUTOS ONLY<br>X NON-OWNED AUTOS ONLY</td> <td></td> <td>MSMML10000000</td> <td>1/1/2023</td> <td>1/1/2024</td> <td>COMBINED SINGLE LIMIT (Per accident) $1,000,000<br>BODILY INJURY (Per person) $10<br>BODILY INJURY (Per accident) $10<br>PROPERTY DAMAGE (Per accident) $10</td> </tr> <tr> <td></td> <td>UMBRELLA LIAB<br>EXCESS LIAB</td> <td>OCCUR<br>CLAIMS-MADE</td> <td></td> <td></td> <td></td> <td>EACH OCCURRENCE $<br>AGGREGATE $</td> </tr> <tr> <td>B</td> <td>WORKERS COMPENSATION AND EMPLOYER'S LIABILITY<br>ANY PREMIUM OR PART TIME EXECUTIVE OFFICER/MEMBER EXCLUDED? Y/N N/A</td> <td></td> <td>123166.204</td> <td>12/1/2022</td> <td>12/1/2023</td> <td>PER STATUTE<br>E.L. EACH ACCIDENT $100,000<br>E.L. DISEASE - EA EMPLOYEE $100,000<br>E.L. DISEASE - POLICY LIMIT $500,000</td> </tr> <tr> <td>A</td> <td>Cargo</td> <td></td> <td>MSMML10000000</td> <td>1/1/2023</td> <td>1/1/2024</td> <td>ACV ($5,000 Ded.) 125,000</td> </tr> </table> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER City of Tiffin 300 Railroad St. PO Box 259 Tiffin, IA 52340 CANCELLATION 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