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CAPL—PEOU <br />ACORO" <br />DATE (MMIDDIYYYY) <br />3/1/2023 <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 />CERTIFICATE OF LIABILITY INSURANCE <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 endomement(s). <br />PRODUCER <br />First National Insurance Services <br />P.O. Box 180 <br />Pequot Lakes, MN 56472 <br />INSURED <br />Community Action of <br />P.O. Box 491 <br />Pequot Lakes, MN 56472 <br />CONTACT Robin Cyr <br />�PHONE <br />(AIC, No. Ext): (218) 822-"86 <br />E-MAIL b roin n <br />A�RESS: @f inorth.c <br />INSURERS) AF <br />INSURER A: West Bend Mutt <br />INSURER B : <br />INSURER C : <br />INSURER D <br />INSURER E : _ <br />INSURER F <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 <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 />TYPE OF INSURANCE POLICY NUMBER ruuGr err FULIGT EXP LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />CLAIMS -MADE r OCCUR X 73379 11H12022 11/1/2023 ooA'MAGceORENTED ` <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY ❑ jra FJ LOC <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />OWNED <br />SCHEDULED <br />X <br />AUTOS ONLY <br />AUTOS <br />AUTOS ONLY <br />p <br />X ,AUTOS ON <br />i <br />UMBRELLA LIAB OCCUR <br />EXCESS LUAB CLAIMS -MADE <br />DED I I RETENTION $ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y I N <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICER/MEMBER EXCLUDED? N I A <br />( arWatory In NH) <br />II Yes. describe under <br />11/1/2022 1 11/1/2023 <br />YINJURY <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more apace is aired) <br />City of Pequot Lakes is named as additional insured in respects to the following events: Splash Pad O- ingg Vent in the Park May 25th; Street Dance & Art <br />Crawl - August 5th; Trick or Treat Event in the Park - October 28th; Santa's Bobbin into Town - December 9th <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Pequot Lakes THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />4638 Main St <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Pequot Lakes, MN 56472 <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2016iO3) ! 01988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />