2001-04-13 Cert of Liab Ins
A'CORD:o- CERTIFIC
OF LIABILITY INSU
DATE (MM/DDIYY)
04/13/01
THIS CERTIFICATE ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
'J. A. PRICE AGENCY, INC.
6640 Shady Oak Road
Suite 500
Eden Prairie, MN 55344
INSURED
Kuechle Underground, Inc.
20 Main Street
P.O. Box 509
Kimball, MN 55353
COVERAGES
INSURERS AFFORDING COVERAGE
INSURERA:Western National Mutual Insurance
INSURER B:
INSURER C:
INSURER D:
INSURER E:
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I~~ TYPE OF INSURANCE POLICY NUMBER ~k!fJ'lifFECTIVE P~~ff [,~\RAIJ~ LIMITS
TE 100
A GENERAL LIABILITY CP300001273 03/24/01 03/24/02 EACH OCCURRENCE $1,000 000
j--
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire $100,000
I CLAIMS MADE[X] OCCUR ME 0 EXP (Anyone person) $5,000
X PD Ded: 1,000 PERSONAL 8. ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 , 000 , 0 0 0
Xl POLICY n ~~gT n LOe
A AUTOMOBILE LIABILITY CA300001536 03/24/01 03/24/02 COMBINED SINGLE LIMIT
~ $1,000,000
~ ANY AUTO (Ea accident)
ALL OWNED AUTOS BODIL Y INJURY
~ $
SCHEDULED AUTOS (Per person)
~
~ HIRED AUTOS BODIL Y INJURY
$
X NON-OWNED AUTOS (Per accident)
~
~ PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONL Y - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONL Y: AGG $
A EXCESS LIABILITY CU30000584 03/24/01 03/24/02 EACH OCCURRENCE $2 000 000
~ OCCUR D CLAIMS MADE AGGREGATE $2 000 000
$
~ DEDUCTIBLE $
X RETENTION $10,000 $
WORKERS COMPENSATION AND IT~~nf:.1:?~1 10ll:;'-
EMPLOYERS' LIABILITY $
E.L. EACH ACCIDENT
I E.L.DISEASE-EAEMPLOYEE $
E.L. DISEASE-POLICY LIMIT $
A OTHER Inland IM300001558 03/24/01 03/24/02 100,000/For Each
Marine- Jobsite Location
Installation Floater
DESCRIPTION OF OPERATIONS/LOCATlONS/VEHICLES/EXCLUSIONS AD OED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate holder has been added to the general liability policy as an
additional insured as per the Additional Insured - Owners, Lessees or
Contractors - Automatic Status When Required in Construction Agreement
With You endorsement. Also named as Additional Insured on the general
(See Attached Descriptions)
CERTIFICATE HOLDER I I ADDIl1ONALINSURED; INSURER lETTER CANCELLATION
SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPlRAllON
SEH.RCM DATETHEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL3...0...- DAYSWRlTTEN
1200 25th Avenue South NOllCETOTHE CERllFICATE HOLDER NAMED TO THE LEFT, BUTFAlWFE TO DO SO SHALL
P.O. Box 1717 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITSAGENTS OR
Saint Cloud, MN 56302-1717 REPRESENTATIVES. .
AUTHORIZ*~PRESE~TIVE
I c,.... . ^ n r'\..U\..}
v
ACORD 25-S (7/97)1 of 3
#M8119
JMK @ ACORD CORPORATION 1988
DE- IPTIONS (Continued from
ge 1)
liability is the City of Albertville.
RE: Albert Villas.
* REVISED CANCELLATION CLAUSE -
Should any of the above described policies be materially changed,
suspended, or cancelled before the expiration date thereof or fail
to be renewed upon their expiration, the issuing company will mail 30
days prior written notice to the named certificate holder.
AMS 25.3 (07/97) 3
of 3 #M8119
'.
e
e
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certifICate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25-S (7/97)2 of 3 #M8119
ACORD", CERTIFIC
14847 KUEUN
OF LIABILITY INSU.NCE
DATE (MM/DD/YY)
04/16/01
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
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
J. A. PRICE AGENCY, INC.
6640 Shady Oak Road
Suite 500
Eden Prairie, MN 55344
INSURED
Kuechle Underground, Inc.
20 Main Street
P . O. Box 50.9
Kimball, MN 55353
COVERAGES
INSURERS AFFORDING COVERAGE
INSURERA:Western National Mutual Insurance
INSURER B:
INSURER C:
INSURER D:
INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE. BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOlWITHSTANDING
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I~f~ TYPE OF INSURANCE POLICY NUMBER P8klCY EFFECJJ~ P?'~-rJ ['~'J6AJ)~ LI Mil'S
A ~NERAL LIABILITY CP300001273 03/24/01 03/24/02 EACH OCCURRENCE $1 000 000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire $100,000
I CLAIMS MADE[X] OCCUR ME D EXP (Anyone person) $5 000
X PD Ded: 1,000 PERSONAL & ADV INJURY $1 000 000
~ GENERAL AGGREGATE $2 000 000
~'L AGGR~nE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 000 000
X POLICY ~~gT n LOC
A ~TOMOBILE LIABILITY CA300001536 03/24/01 03/24/02 COMBINED SINGLE LIMIT $1,000,000
~ ANY AUTO (Ea accident)
~ ALL OWNED AUTOS BODIL Y INJURY
$
SCHEDULED AUTOS (Per person)
~
cb HIRED AUTOS BODIL Y INJURY
$
~ NON-OWNED AUTOS (Per accident)
..~ PROPERTY DAMAGE $
(Per accident)
~RAGE LIABILITY AUTO ONL Y - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONL Y: AGG $
A EXCESS LIABILITY CU30000584 03/24/01 03/24/02 EACH OCCURRENCE $2 . 000 000
::la OCCUR D CLAIMS MADE AGGREGATE $2 , 0 0 0 , 000
$
=;j DEDUCTIBLE $
X RETENTION $10,000 $
WORKERS COMPENSATION AND IT~2;m1:?~ I IOll:;'-
EMPLOYERS' LIABILITY E.L. EACH ACCID!:~__ ..L_________
E.L.DISEASE-EAEMPLOYEE $
E.L. DISEASE-POLICY L1MI $
A OTHER Inland IM300001558 03/24/01 03/24/02 100,000/For Each
Marine- Jobsite Location
Installation Floater
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate holder has been added to the general liability policy as an
additional insured as per the Additional Insured - Owners, Lessees or
Contractors - Automatic Status When Required in Construction Agreement
With You endorsement. City of Albertville is also named as J.4J\lJ;;h Itf&,;LJ '1 \'/1 1,::1 1\
(See Attached Descriptions) . i j 'J' ,. ] II \J ,.~_.l I [', '
i';:': .~. f .~:~'::J \:') i ~:-~J t~:Ji
CERTIFICATE HOLDER I I ADDmONALlNSURED'INSURER lETTER: CANCELLATION in I; "I
,
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BF CAN"~ BIi'~~~:tRAll9N
SEH.RCM DATETHEREOF,THE ISSUING INSURERWILL~NDfAVO OriAl~ 'Nft RITJE/-.I
1200 25th Avenue South ' , t
NOllCETOTHE CERllFICATE HOLDER NAMED lpT/-iE LEFT, BUTFAILURE TO DO so SHAL.
, \ ~ t.
P.O. Box 1717 IMPOSE NO OBLlGAllON OR LIABILITY OF ANYklND UPSN-'l'HetN9URER;1TS'AGENTSO.
Saint Cloud, MN 56302-1717 REPRESENTATIVES. ,'.. : ~ j:- .,( : t, t :;t_.i\~;_):;<;Lr-~..~),,;,-.-~
" ~ ., ,.
AUTHORIZED REPRESE~TIVE ,
I Q,.It. . ft~ -' ^ ,. n-'Y\...V\...)
v
ACORD 25.S (7/97)1 of 3
#M8119
JMK @ ACORD CORPORATION 1988
DE.IPTIONS (Continued from ege 1)
Insured on the general liability.
RE: Albert Villas, phase II. SEH File #A-ALBEV 0012 14.
* REVISED CANCELLATION CLAUSE -
Should any of the above described policies be materially changed,
suspended, or cancelled before the expiration date there of or fail
to be renewed upon their expiration, the issuing company will mail
30 days prior written notice to the named certificate holder.
AMS 25.3 (07/97) 3
of 3 #M8119
*
1 ..
e
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD25-S(7197)2 of 3 #M8119