1998-07-27 Certificate of Insurance
r
TRANSMITTAL
03535 VADNAIS CENTER DRIVE
200 SEH CENTER
ST. PAUL, MN55110
612490-2000
800325-2055
612490-2150 FAX
o 5909 BAKER ROAD
SUITE 590
MINNETONKA, MN 55345
612931-9501
800 734-6757
612931-1188 FAX
t6 113 S. FIFTH A VENUE
P.O. BOX 1717
ST. CLOUD, MN 56302-1717
612252-4740
800572-0617
612251-8760 FAX
o 421 FRENETTE DRIVE
CHIPPEWA FALLS, WI54729
715720-6200
800472-5881
715720-6300 FAX
06410 ENTERPRISE LANE
SUITE 120
MADISON, WI 53719
608274-2020
800 732-4362
608274-2026 FAX
D 2001 CLINE AVENUE N.
SUITE 206
LAKE COUNTY, IN 46319
219838-7097
219838-7089 FAX
An Affirmative Action,
Equal Opportunity Employer
TO: Dave Lund
City of Albertville
July 27, 1998
Date
A-ALBEV 9813.00
File Number
Albertville, Minnesota
Client
RE: 1998 Cedar Creek North
We are
,t Enclosing
o Sending Under Separate Cover
o As Requested
1 Certificate ofInsurance, 07/17/98
For your
.6 Information/Records
o Review
o Approval
o Action
o Distribution
o Revision and Resubmittal
REMARKS:
Peter J. Carlson, P.E.
BY djg
J:\albev\9813\corr\)127a-98. wpd
JUL-17-9S FRI 14:59
"
r"^~).iCCJRO~- CERTiFICA T:E OF LIABILI!!.INSURANC.E E~~TEOl DA~~i;;/~;
I pnOOllCel1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
AL TER THE COVERAGE AfFORDED BY THE POLICIES BELOW.
_. ..........k._..___.._ _~_._.____.__
COMPANIES AFFORDING COVERAGE
. . ------. .----- -- -. ------ --------.
PIERCE AGENCY LITCHFIELD
FAX NO.
13206933452
P.01
Pierce Agency, Inc.
P.O. Box 418
Litchfield MN 55355
David W. Pierce, CIC
~b9!!.~.!>c_u__~_~P~~ ~.3 ::6115 uF.~~~,_.
INSURED
COMPANY
A CNA
COMPANY
B state Fund Mutual
LaTour Construction, Inc.
2134 Co. Road 8 NW
Maple Lake MN 55358
_". ~ _" "h.~ .."., _..
COVERAGES
THIS IS TO CERTIFY THA T THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INOICA TED. NOTWITHSTANDING ANY REOUlflEMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TillS
CFHIIFICATF MAY BE ISSUE[) OR MAY PERTAIN. THE INSURANCE AFFORDED BY TilE POLICIES DESCRIBED HEnEIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LiMns SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
mE OF INSURt\NCE ] POL~V NUMBER' . - m.....---~i;~~~;;\i~g;~;l ]p~~~:'(i~~~i~ru u
COMPANY
C
COMPANY
o
CO
LTR
LIMITS
l..
I GE~ERAL LIABILITY
A X C()MM~RCIAL GENERAL LIABILITY
.., '. CLAIMS MADE [~] OCCUR
, OWN~R'S .... CONTRACTOR'S PROT
,
Application Bound
06/04/98
06/04/99
G~NERA..L.",~~.~EG~.e..,. s 2,.00o.!. ~~.Q__.__ .
.P'R~?U.C.T..S:<:().~.p'/oP AGG $ 2 '()~€?LQ()<?u
!,~_~~.O_~",.I: .... ADV INJURY 5,!.! .o...Cl.Q.Lo..()<? .
EACH OCCUR~E.~':.~._.u_..._ . ~.J ,_ oo.()! OClO
FIRE DAMAG~ (AllY one fire) .~...u,_ ._~.~.L ()()O.
MED EXP (Anyone persoll) 5 5,000
... .... ._...__L._____,_._______
. AUTOMOBILE LIABILITV
A X ANY AUTO
ALL OWNED AUTOS
SCH~OULED AUTOS
'X HIRED AUTOS
X NON-OWNED AUTOS
Application Bound
06/04/98
06/04/99
COMBINED SINGLE LIMIT $ 1,000,000
BODILY IN,IURY ! $
(Per pefson}
BODILY INJUflY
(Per accident)
~_._._--_.-
PROPERTY DAMAGE
GARAGE LIABILITY
1 ANY AUTO
i
AUTO ONLY. EA ACCIDENT $
'.'~~"._h .~. ___ . _h.'__._ ____._____
OTHER THAN AUTO ONLY:
EACH ACCIDENT $
I
_ . _... .....1_..___ ..,...__.___..._....._...... .., ......... ..._............ _. ....__......._...._____,__",._.._
, !;)(CESS LIABILITY
AGGREGATE
s
.s.2IQO.O,OOO
$2 !~OO,O()O
$
EACH OCCURRENCE
A X liMBR"1 LA FORM
Application Bound
06/04/98
06/04/99
AGGREGATE
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOY ERS' LIABILITY
B THE I'ROPRIETOI1/ . INeL 00089.315
. PARTNERS/EXECUTIVE "1
.- -"j'~~~i~~;i~.~R.~~.----_l..~C:~ .
A : Builders Risk i APP
. . f"JR~I~~~;;T-'1oJ~:
OS/28/'8 OS/28/"1 :~ ::,';;:;C:',:, "M"
EL DISEASE - EA ~MF'LOYEE
_ _ . .... _0~~O'~:8 _:./o'~"J _ _ .
$~OQJ O_~~
..S...~QQ..!. Q,QO_____.
$ 500, ~OO
. .,.~___._.. ....__1_.__.___._.._.....,_._,
-OESc'Rlp:nON OF OPEnATIONSlLOCATlONSNEHICLESlSPEC1AL ITEMS
The Work~rs Compensation policy limit applies to accident and disease
The cert1ficate h~l~er, C+ty o~ Alb~rtv111e, SEH, Inc., and Meyer-Roh1iq,Inc
are 1is~ed as add1t1onal 1nsureds w1th regards to Cedar Creek North proJect
P II.OTLA
CANCELLA liON
Should any of tbf tbove described ;lolicies be mlt!riaIly chUl.lIa\
SU!P~ded, or e~led before the ~pintiou. d1.tc chereot or ~ to
~ r~ewed up Oil. dtei.r expineionl the iSSl.W11 l:Olill*1Y will mail 30
daY' written noti.:e co the rwned. cutifica.te liolQ~r.
~F. : .'1" ......".
~u:::n:EDwR~PR;S::;::E, -~;lf tM;/~~-'"'-'-
@ACORD CORPORATION 1988
CElHIFlCA lE HOLDER
Pilot LRnd Development, Inc.
13736 NE Johnson St.
Ham Lake MN 55304
_A..S.?~!?..~_~~ J.~!~~L"_,"_"__"'__h ~_._~.__ ,~__.~___.._~.~ ~,"".. ....",.__.".. " ,,,_,.,,.-,,,_ ......."..___.___........_.___... _. _...__... '_" "Co"'"."
JUL-17-9S FRI 15:00
PIERCE AGENCY LITCHFIELD
FAX NO, 13206933452
p, 02
.,i ,
'A'COR,QM
CERTIFICATE OF LIABILITY INSURANCE EK~TE01 D~;(M~;D~~
THIS CERTIFICATE IS ISSUED AS A MAHER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
AL TER THE COVERAGE AFFORDED BY THE POLICIES BelOW,
COMPANIES AFFORDING COVERAGE
PI10DUCER
Pierce Agency, Inc.
P.O. Box 418
Litchfield MN 55355
David W. Pierce, CIC
Pl\2..n~l!.o. __m~_~9-=_~,Sl ~_~_!__?m_ F.x.!!~,
INSURED
COMPANY
A CNA
COMPANY
B
state Fund Mutual
LaTour Construction, Inc.
2134 Co. Road 8 NW
Maple Lake MN 55358
COMPANY
C
COVERAGES
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
CFRTIFICA TE 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.
&~ ~ .- TyrE OF I~~URAN:~' ---- T-- d..----~:~r~YJi~~BER -- -~i~~~~~;i:;- P~~~~ {~~~~i~~~~ r - liMITS
.. '.. t~~N;;;:~-~~~l~TY---'--- Ii G~.r-J.~RAL AGG~_E~':'-r:.E _ ~_~ .L.oOO ,O!)O
A ; X-I' COMMERCIAL GENERAL LIABILITY App1 ication Bound 06/04/98 06/04 /99 P~ODUC_T.:'.__ c~~!,!OP:,,~~ _~__~.Lq.!>gL~QQ.._
'I . 1 r.l-^IMS MADE !il OCCUR , PE~~.~~!:.. 8. ADV IN.JUR~_ _~_}. _,_()_Q.Q.L!?().l?___
J ow,,,, ~ ""M';;" e~:l__~____::::;;:~:;:,:~ - r' Q~!:~!-
i .A_ U.,._T.OMO~ILc LIABILITY : $ 1,000,000
f I COMBINED SINGLE LIMIT
A . X; ANY AUTO Application Bound 0.6/04/98 0.6/04/99 _________ _, ____ ___________
AI.L OWNED AUTOS BODILY INJURY ~
~_~1- ~~~~~:::A;~-:---~=---
COMPANY
D
'f SCHEDULED AUTOS
X HIRED AUTOS
X NON-OWNED AUTOS
. \
-.-...Ll_:..,.-.
l (l0~AGE LIABiliTY ~'
. [NY AUTO
i : __..____ . _.
,------..L--. .------ ----.
I I EXCESS LIABILITY
A ! x'] UMBREl.LA FORM
, i OTHER THAN UMBRELLA FORM
.-.- -;-I';:';;;~Ef1S CO;PEflSATION AN-;-
EMPlOYERS' LIABILITY
---t----.----- --
B i THE PROPRIETOR/ [];-- INCI. : 0.0089 .315
lPARTNEfiS/EXECLlTIVE -- "'j
OFFICERS ARE: EXCL
--- ..~ ..--~-------- - ---
! alliER
I
A i' Builders Risk APP
,____..1.,_.._.__.___.___.....___..__. ... ..... _____n_____~_
DE,,;CRlPTlON OF OPERATlONS/LOCATIONSNEHIClEsISPECIAlITEMS
The Workers compensation policy limit applies to accident and dise'llse
The Certificate Holder, C1ty of Albertv111e, SEH,Inc. & Meyer-Rohl1n, Inc.
R~e list~d as additional insureds with regard to the Center Oaks 3rd Addn
project
AUTO ONLY - EA ACCIDENT
$
OTHER THAN AUTO ONLY:
EACH ACCIDENT
AGGREGATE
$
$
.. ~ 2 , 0 O_Q.L<? 0.9___
$ 2, Oo.Q-,_P.~()___
$
EACH OCCURRENCE
Application Bound
0.6/04/98
06/04/99
AGGREGATE
OS/28/98
OS/28/99
06/04/98
06/04/99
CHHIFICA TE HOLDER
CANCELLATION
CENTERO
Should Uly 01 the 1bove described pollcies be Ir..3.terially ChUlB~
SUSpetlded, Or canceled before the ~imtion d-acl: thtreoC. Ol" fail to
b~ r4!;lJ.ewed upon. their expil"\\cioll,. the ;~suin, company will mail 3Q
dll.)'$ written~~;e ~o the m.me(c:~cace nQ,ld~r. _
AUTHORIZF.D REPRESENTATIVE -- 677 -----~--'-:(, ,.... /.1 I -
David W. Pierce, C~'U:virC~~~988
Center Oaks Partnership, LLC
13136 NE Johnson St.
Ham l,ake MN 55304
ACOflD 25-5 [1/95)