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OP ID:S6 <br /> A °RL CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYY`r) <br /> 09/25/13 <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 be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER 701-347-4485 CONTACT <br /> Bremer Insurance-Casselton E` <br /> P O Box 310 701-347-5644 I No,�): FAX No): <br /> Casselton,ND 58012 E-MAIL <br /> Marcene L.Hoffmann ADDRESS: <br /> PRODUCER CASSC-1 <br /> CUSTOMER ID#: <br /> INSURER(S)AFFORDING COVERAGE NAIC• <br /> INSURED Cass County Wildlife Club INSURER A:Philadelphia Insurance Co <br /> Attn:Ken Klingstein <br /> P.O.Box 336 INSURER B <br /> Casselton,ND 58012 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 /> `IS TYPE OF INSURANCE ADDL.BURR POLICY EFF POLICY EXP OMITS <br /> INSR WVD POLICY NUMBER (MMIDD/YYYY) (MM/DDIYYYY) <br /> GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000 <br /> A X COMMERCIAL GENERAL LIABILITY PHPK1071811 09/15/13 09/15/14 PREMI EI(RENTED 100,000 <br /> PREMISES(Ea occurrence) $ _ <br /> CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> X POLICY 7 JFf.T I LOC $ <br /> AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT <br /> (Ea accident) <br /> ANY AUTO <br /> BODILY INJURY(Per person) $ <br /> ALL OWNED AUTOS <br /> BODILY INJURY(Per accident) $ <br /> SCHEDULED AUTOS <br /> PROPERTY DAMAGE $ <br /> HIRED AUTOS (Per accident) <br /> NON-OWNED AUTOS $ <br /> $ <br /> UMBRELLA UAB _ OCCUR EACH OCCURRENCE $ <br /> EXCESS UAB CLAIMS-MADE AGGREGATE <br /> — $ <br /> DEDUCTIBLE $ — <br /> RETENTION $ $ <br /> WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS'UABUTY YIN TORY LIMITS ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? n N/A <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ <br /> It yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,II more space Is required) <br /> RE: 9-14-13 Duck Hunt <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE <br /> Cass County Wildlife Club THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ty ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO BOX 336 <br /> Casselton,ND 58012 AUTHORIZED REPRESENTATIVE <br /> I <br /> Silt it on 5 Grei#4.) <br /> m 1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 26(2009/09) The ACORD name and logo are registered marks of ACORD <br />