2002-03-22 Cert of Liability Ins
.,
ACORD....
Client : 14847 KUEUN
OF LIABILITY INSU.CE
DATE (MM/DD/YY)
03/22/02
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
INSURERS AFFORDING COVERAGE
INSURERA:Western National Mutual Insurance
INSURER B:
INSURER C:
INSURER D:
INSURER E:
INSURED
Kuechle Underground, Inc.
20 Main Street
P.O. Box 509
Kimball, MN 55353
COVERAGES
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~SR TYPE OF INSURANCE POLICY NUMBER Pgk!fJ/Kr~Tn1I~ "9.'K~ !i~~~AJJ~ LIMITS
TR
A ~NERAL LIABILITY CP300001273 03/24/02 03/24/03 EACH OCCURRENCE $1.000 000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire $100.000
I CLAIMS MADE[X] OCCUR ME D EX? (Anyone person) $5 - 000
- PERSONAL & ADV INJURY $1.000.000
- GENERAL AGGREGATE $2 . 000 . 000
~'L AGGR~rilllMIT An PER: PRODUCTS-COMPIOP AGG $2 . 0 0 0 . 000
POLICY X ~~~T LOC
A ~TOMOBILE LIABILITY CA300001536 03/24/02 03/24/03 COMBINED SINGLE LIMIT $1,000,000
~ ANY AUTO (Ea accident)
- ALL OWNED AUTOS BODIL Y INJURY
$
SCHE DULED AUTOS (Per person)
~
>-- HIRE D AUTOS BODIL Y INJURY
$
NON-OWNED AUTOS (Per accident)
~
>-- PROPERTY DAMAGE $
(Per accident)
RAGE LIABILITY AUTO ONLY- EAACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONL Y: AGG $
A EXCESS LIABILITY CU30000584 03/24/02 03/24/03 EACH OCCURRENCE $2 000 000
tlIT OCCUR D CLAIMS MADE AGGREGATE $2 000 000
$
~ DEDUCTIBLE $
X RETENTION $10 000 $
A WORKERS COMPENSATION AND WC300001273 03/24/02 03/24/03 X IT"Xg.ml1~cJ lOll;'
EMPLOYERS' LIABILITY $100.000
E.l. EACH ACCIDENT
E.l. DISEASE-EA EMPLOYEE $100,000
E.l. DISEASE-POLICY lIMI $500.000
OTHER
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. Also named as Additional Insured on the general
(See Attached Descriptions)
CERTIFICATE HOLDER I I ADDmONALINSURED:INSURERLETTER: CANCELLATION
SHOULD ANYOFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAllON
SEH DATETHEREOF,THE ISSUING INSURER WILLENDEAVORTO MAIL3.0- DAYS WRITTEN
1200 25th Avenue South NOllCETOTHE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
P.O. Box 1717 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
Saint Cloud, MN 56302-1717 REPRESENTATIVES.
AUTHORI~fr~PRESE~TIVE
I 0,,... ~ -' A I>~
v
ACORD 25-S (7197)1 of 3
#M9186
JMK @ ACORD CORPORATION 1988
~
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 #M9186
DEselPTIONS (Continued from .e 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 #M9186