2000-08-11 Certs of Ins
,
~ent by: J .A. Price Agency, Inc._
~ .,
b
9529440097;
08/141t000 4:21PM; #434; Page 1/7
I. ~.A.
PRICE AGENCY. INC~
6640 SHADY OAK ROAD, EDEN PRAIRIE, MN 55344. 612-944-8790. FAX 612-944-0097
www.japrice.com
TO:
~~~'^ y~ 11-. 00
C': ") -,
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(~ Pde Cor~'SD-<:LL WC<L1''''
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DATE:
ATTN:
c~.:)-t tA-r (C.-
FROM:
RE:
Number of pages sent (including cover sheet) --I
,JMK/S9399
"BUSINESS AND PERSONAL INSURANCE SPECIALISTS"
08/11/00 FRI 14:56 [TX/RX NO 7253]
'ACORD.,.
J.A. Price Agency, Inc. 9529440097; 08/11/2000 4:21PM; #434; Page 2/7
Client ~4It4847 ~UN
CERTIFICATE OF LIABILITY INSURANCE
1
3ent by:
RODUCER
r. A. PRICE AGENCY,
;640 Shady Oak Road
,ui te 500
~den pra irie, MN
INC,
DATE (MMIDDIYY)
08/11/00
nus CERTIFICATE IS ISSUED AS A MATTER OF INFOFlMATION
ONLY AND CONI'ERS NO RIGHTS UPON THE CERTIFICATE
HOlDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
ALTER THE COVERAGE AFFORDED flY THE POLICIES fiE LOW.
55344
INSURERS AFFORDING COVERAGE
INSUREAA:We'stern National Mutual Insurance
~SURE 0
Cuechle Underground, Inc.
W Main Street
) o. Box 509
Cirnba 11, MN 55353
:OVERAGES
INSt)Rf.OR B:
: INslJfl!::R c:
INSURER D:
: INsuflER to:
THE poucJt::s Of. INSUMNCE USTED BELOW HAVF BEEN ISSUED TO THE. lNSUIlf.:D NAMED ABovE fOA THf. POLICY PERIOD INDICATFD. NOTWITHSTANDING
ANY nr'QUlflEMENT, TERM OR cONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CFflTlFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POuciES DESCRIBED HEREIN IS SUBJECT TO All THE TERMS. FXClUSJONS AND CONDITIONS OF SUCH
POLICIES. AQQREOATE LlMITS SHOWN MAY HAVE BEEN REDUCED t)Y PAID CLAIMS.
iSft!m.-n_.__.___m.......".-.'.- .... .... ~POLICYEFFEctiVE:POUCYEXPIRAtio~r'-'-.
TR ' TYPE OF INSURANCl;' POLlCY NUMBER : DATE fMM/OO/YY)i DJ\!I' (MMIOO/Vn LIMITS
l\ : GENEAALLlABILlTYCP300001273 i 03/24/00 : 03/24/01 : EACHOCCVRRENCF. : n., 000,000
XC()MMERCJALGENERAL~IAaILlTY ! ..: FIREDAMAQE (Anyone fJr"~ 51,00,000
ClAIMSMADEi X:iOCCUR: ;MEDEXF'(Anyonoporsofl) ,$5,000
. PERSONAL &ADV INJUm . S 1, 000,000
: ClENfRAlAGGREOAT!': '52 JOOO, 000
: PRODlJCTS.COMP/Of' A<lojs2 , 000 , 000
GFN1. AGGIlEGATE LIMIT APPlIFSPER:
: X. PRO.
POl~Y' i JECr 'LaC
/'\.
AUTOMOBILE LIABILITY
X ANV AUTO
ALL OWNED AUTOS
: "'GHFD\JLED AUTOS
X, HIf1EDAUJ05
X . N(lN.OWN!7[) AUTOS
i CA3 0 0 0 0 1536
,
i,03/24/00,03/24/01:
, COMBINED SINGI.!:' LIMIT '. $l , 000, 000
i (Ea acclOMt)
i BODilY INJURY
~ (Per per:.oo)
: BODILY INJURY
; (P~f 3ctfdent)
$
: PROPERTY DAMAGE
; (Po" acclOent)
$
GARAGE UABILlTY
ANY AUTO
/'\.
CU30000584
AUTO ONLY.. EAI\GCIDENT' $
, ! OTHER TitAN E AACe; $
; I AUn.J ON!, y, AGG : S
, 03/24/00 : 03 /24lO'11 EACH QCCURRENCE F~., 000, 000
. i AGGREGATE .i$2/0 0 0 , 000
; j $
EXCESS LIABILITY
X' OCCUR
. .
: CLAIMS MADE!
i
,
DEDUCTIBLE
s
X RCTENTIONSl 0 000
WORKERS COMPENSATION ANe
EMPLOYERS' LIA81LITY
OTHER
$
'.''':'wC STATu. OTH-,
, :TORY LIMITS.: .........;....108...'_...._..
: E.L,!,:A_c:.t:l_A,CCIOENT S
i ELDISEASE-E',Af.;MPLOYEE;$ ...
! EL DISE'A,Sf:' .POLICY LIMI-r S
.
)ESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS AD DE D BY ENOORSl:MENTlsPECIAL PROVISIONS
2ertificate holder has been added to the general liability policy as an
3dditional insured as per the Additional Insured - Owners, Lessees or
2ontractors - Automatic Status When Required in construction Agreement
with You endorsement.
RE: Albert villas, Phase II.
c;ERTIFICATE HOLDER
, AODfT1OI'iALINSUl'EO;I~~
CANCELlATION
SHOULOANTOFTHE A50\/!'! OI!SCAl BE 0 POLICIES BE CANCELLED BEF~ THE E)(?lRATlON
DATETHEREOl",THEISSUINBINSURERWlLLENOEAVORTOMAtL3 0 DAVSWRlTTEN
NUTlCETOTHE CERT1FICATE HOLDtOR NAMED TOTHE LEFT. BVTFAlLUAE TO 00 SO SHAll
IMPOSE NO OElLIQATION OR LtAlOlLlTY OF> ANY KIND UPON THE INSURER,ITS AGENTS OR
SEH.RCM
605 Franklin Ave. South
P.O. Box 51
Saint. Cloud, MN 56302-0051
#M6942
ACORD 25-5 (7/97)l of 2
JMK
@ ACORD CORPORATION 1988
..;.....:.....:.......~.:::;.:.;...:..........:.d;."....
..................... .
... ,', ..........: ..~..;..
08/11/00 FRI 14:56 [TX/RX NO 7253]
SenT by: J.A. Price Agency, Inc.
9529440097;
08/11/2000
4:21PM; #434; ~age ~~
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. A statement
on this certificate does not confer rIghts to the certificate holder in lieu of such endorsament{s).
It 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 conter rights to the certificate
holder in (leu of such endorsement{s).
DISCLAIMER
The Certificate of Insurance on the reverse skJe 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.
I\CORO 25-S (7/97)2 of 2 #M6 94 2
08/11/00 FRI 14:56 [TX/RX NO 7253]
Sent by: J.A. Price Agency, Inc. 9529440097'
~~ient :~4847 '
08/1~000
.UN
4:21PM; #434; Page 4/7
--.---' f#
"OOUCER
r A. PRICE AGENCY,
;640 shady Oak Road
;uite 500
~den Prairie, MN
INC.
0"" Te (MMfDOfVY)
08/ll/00
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 AFFOR~~D !:tV THE ~l..IC1E$ BEL5?:v'!:~
4C()RTJ.>>
CERTIFICATE OF LIABILITY INSURANCE
55344
INSURERS AFFORDING COVERAGE
1~.~URER~;Western National Mutual Insurance
INSUREA B:
INSURER C:
INsuRER D:
INSURER E'
tSUREO
~echle Underground, Inc.
~o Main Street
) O. Box 509
Cimball, MN 55353
:OVERAGES
THE poUClFS OF INSURANCE LlS1UJ OF-LOW HAVe SF-EN ISSUED TO THE INSURED NAMED ABOVE FoR rHF POLICY pERIOD INDICAlfD. NOlWllHsTANDfNG
ANY REQUiREMENT. TEAM OR CONDrrlON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECr TO WHICH nus Cl:;RTIFICATE MAY BE ISSUF,D OR
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES D€SCPlaED HEREIN IS SUBJ(CT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS of SUCH
POUClES. AGGREGATE LIMITS SHOWN MAY HAVE 6EEN REOUC!':D BY PAID cLAIMS.
IsFi,HHH u_...' ; . .......,.pc,.L1CY.eFF.EotlvEiP6UCYEXPlRATf6~-H
.I.B..L,...~..1YPE OF tNsuR_ANce ..! POLICY NUMBER : OAlF tMMfOOlm: DAre (MM/DD/ml LIMITS
l';. GENE;RALLlAllILlTVCP300001273 !03/24/00 :03/24/01 !EACHOGCtJRRENCE ;$1,000,000
X : COMMtRCtAI. OENERALl.'AfllllTY ' . ; I-IRF DAMAGE (Anv.<me fU..j sl 00, 000
CLAIM!; MADE: X: OCCUR! : MEDI'XPIAny "n. p~rSon) .55.,...0.00
; PERSONAl & ADV INJVAY,$l, 000 La 0 0
i GENERAL MlOREtlATF : 52 ,QO 0, 000
! PRODvcfS.COMPIOP AG"52, 0 0 0,000
· : i ~-
; 03/24/ 00 ~,i 03/24/0 l ! fE~~<~\~;n~)5IN()LCLlMIT i sl, 000, 000
: BODll..Y INJURY
! (Per person) $
GEN1.. A(,OREOATE LIMIT APPL IES PER; i
., 'I Pflo- I' ,.
~~.!,'Oll(;Y: X, JECI I : I.OC.... .
A AUTOMOBilE lIA81L1TY ; CA3 0 0 0 0 15 3 6
X ANY AUTO
All. OWNED AVTOS
: 5CHEDf.}l._EfJAUTO~
X : HIReD AUTOS
X ; NDN, OWNE D AUTO'"
: BODILY INJuny
i (por ~ccid.ent)
I
, PROPERTY DAMMiF
! (per ,,-c!;Went) .
$
is
:
A
CU30000S84
Ct..AIMS MADE:
;03/24/00i03/24/01
; AUTO ()NL Y - FA ACCIDENT] S
E::A Ace : $
I
_.000 i s
; EACHOCClJRRENCE . ' $2 , 00 (), 000
, AOOREaATf, . $2 , 000, 000
!m_ s
$
GARAGE LIABILITY
ANY AUTO
i OTHeR THAN
: AUTO ONL Y.
: DEDUCTIBLE
X RETENTION ,d 0000
WORKeR'" COMPENSATION AND
EMPLOYERS'lIA.BILITY
, WCSJ"I-U~ . on...
I !TOflY l.JMITS' .l.ER.;....
~E.L.EACH ACCIDE./'lT : 5
; EL.DISEASE,Ei\EMf"LOYEr;: $..
i E.!.. DISI"ASE.POl.lCY lIMrr:J
OTHER
Dl:SCRIPTION OF OF'l!RATIONS/LoCATIONSIVEHICLESfEXCLUSIONS ADO~D BY ENOORSeMENTfSPECIt\L PROVISIONS
Certificate holder has been added to the general liability policy as an
additional insured as per the Additional Insured - Owners, Lessees or
ContI'actors - Automatic Status When Required in Construction Agreement
With You endorsement.
RE: Albert villas Phase II..
CERTIFICATE HOLDER
: AoorOONAI.INSlJREC'INSUAERL.ETI1:Jt
CANCEUATION
SHOULD ANY OF THE ABOVE OESCI'IlBED POUCIES aE CANcelLED BEFORE iHE E>>>IFlATlON
OATE1HERl!!OF,THE ISSU1Ntl INSURER WIllENDEAVORTOMAIl3 0 DAYSWfllTTl'"1II
NOTICEJO THE CEFlTIFICATC HOLDERNAMEC TO THE lEFT, 6vr FAILURE TO 00 so SHALL
IMf'OSI01 NO OBLl13A'fION OA L1MllllTY OF AN" KIN D UPON THI'; INSURER.lfS AGENTS OR
Edina Development Corp.
700 Industrial Corp.
Anoka, MN 55303
ACORD 25. S (7)9'l)l 0 f :2
#M6942
.JMK iD ACORD CORPORATION 1988
08/11/00 FRI 14:56 [TX/RX NO 7253]
Sent by: J.A. Price Agency, Inc.
e
9529440097;
08/11000
4:22PM; #434; Page 5/7
IMPORTANT
If 1he 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 tarms and conditions of the policy, cenain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
hOlder In lieu of such enoorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constltute a contract between
the issuing insurar(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 theroon.
ACORD 25-S (7/97)2 0 f 2 #M6 942
08/11/00 FRI 14:56 [TX/RX NO 7253]
Sent by: J.A. Price Agency, Inc.
.i!Cl1lill:>A
~847N
CERTIFICATE OF LIABILITY INSURANCE
C.lient
.~,,_~52944~o.,~!_~_.....
08/11/2000 4:22PM; #434; Page 6/7
-"
~ODUCER
r. A. PRICE AGENCY f
;640 Shady Oak Road
;uite SOO
~den Prairie. MN
INC.
DATE (MM/DDIYY)
08/11/00
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONl.Y AND CONFERS NO RIGHTS UPOfoI THE CERTIFICATE
tiOlDER. 1HIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED ~v THE pqUCIES BE.I:,gW_
~SUAE D
~echle Underground,
~o Main Street
) O. Box 509
(imball, MN 55353
Inc.
INSURERS AFFORDING COVERAGE
INSURER~;Wef;.l::.erii N(:it:.-{C>D?}-.. Mutual
INSURER B:
INSURER C:
INSURER 0;
INSURER 1;":
Insurance
55344
~OVERAGES
THE POllClF.S OF lNSU!1ANCE LISTED BELOW HAVE BEEN ISSUED 10 THE INSurlED NAMI::D .ABOVE FOR THF POLlCY I'FRIOD INDICATED. NOTWITHSTANDING
ANY RtQUIREMENl. TERM oR CONOITlON OF ANY CONTRACT OR OTI-lER DOCUMENt WITH RESPECT TO WHICH THIS ciORTlFlCATE MAY BE iSSUED OR
MAY pERTAIN. THe INSURANCE: AFFOfll;>I,O BY THE POLlCES DESCRIBED HEREIN IS sUBJfCT TO All TI-lE TERMS. EXCLUSIONS AND CONDITIONS Of' sUCH
POLICIES. AGGREGATE LIMITS SliOWN MAY Hi\",E BEEN REDUCED BY PAID CLAIMS.
~sFi; ! POCicy EFfECfivEiPoLlCYEXPiitATloNf
_m ' TY~ OF INSLJRA~_CE i. poLICY NUMOER ! DATE (MMIOOfy)')' DATE IMMlDDIYYl' LIMITS
A GENERAl-LIABILITY iCP30000~273 ;03/24/00 \03/24/01 if.ACHOCCURRENCr:: ;$1,000,000
X . COMMERCIAL GENERAll.,lABILlT'l ; ..:; !'IAE DAMAGe. (Any 0119 Ilr"~ $~ 0 0 , 000
CLA,MS MAD'" X: O<;CUR: : Men EXP(Any one person) : $5 , 000..
i PFASONAL & AI)V..INJUAY )(1" 000, 000
i GENERAL. AOGREOATELs2 1000, 000
, PROOUCTSCOMf'IOP AGO! $2 1 000, 000
A
GEN1_ Aoar~EQATF UMIT AF'Pl.Il:SPER, i
: :. t PRO.! ~ !
pOLICY' X : JElJT .. ' , lOC I
AUTOMOBILE LIABILITY \ CA3 00001536
X ANY AUTO
ALL (JWNED AUT05
5CHEOUlED AulOS
X HIR':" AU,OS
X NON.OWNE:OAUTOS
. .
. .
::.03/24/00;....03/24/0ll
~ . COMBINED SINGLE: LIMIT
: (Ea accjd~nt)
1$1,000,000
r
: BOOIL Y INJURY
: {Per person)
:$
AT EXCESS LlAB~rrf
: X OCCuR ! ...
. !CU30000584
. CLAIMSMADEi
: BODIL Y INJUn v
, (per acclcJenl)
! PRQPERTY-DAMAG~
! (Per ac"ldet1l)
. ; .....
: IIUTOONLY- EAACCIDfNT: $
i OTHER THAN [A ACe j S
. AUTO ON1..Y: AOG i $
i 03/24/00 . 03/24/01 i EACH OCCURREI'l()EH . $4 LOOO , 000
. i A(}GREGATE ___d___H i s2 t.. 000 , 000.
! : $
;
, $
'$
GARAGE UAB1UTY
ANY AUTO
OF DucTIBLE
X RETE.!:I."'JN sl 0 0..9 0
WORKERS COMPENSATION AND
EMPl-OYERS LIABILITY
:$
._~J
; we STATU-' '011!-
'TORY. 101M ITS.' .. : ER. j......_....
: E_.I,_:.cACH ACCIOEN, $
l E.LD)SF,;AS~:E.b~EMPLOYEE; :$
i1=.t.DISEASE-POLICYUMlri $
OTHER
lJE SCRIPTION OF OPERA TIONSfLOCATIONSIVE'HICLeSfEXOLU510NS AD DE 0 BY ENOORSEMENTfSf'ECIA L 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.
RE: Albert Villas, Phase II.
CERTIFICATE HOLDER ADDmONALIN6I.lAaD-INSUAERlETTEI'l: CANCEUATION
SHOULD ANY OF THE ABOVE DESCRll;!ED POuoESBE CANCI:;LtED BEl'ORETHEEXPlRATtON
OATETHEREOF,THEISSUING INSURER WtUIONOEAVOR TOMAJI.3 0 DAYS WRITTEN
NOT1Cf:TOTHE cERTIFICATI: HOLOEf\ NAMED TOTHE LEFT. BIJT FAILURE TO 00 so SHALL
City of Albertville
5975 Main Ave. NE
P.O. Box 9
Albertville, MN 55301-0009
IMPOSE 1110 011 LlGATtON DR LIABILITY OF ANYl<IND UPON THE lNStJA!;R,ITSAGENTS OR
ACORD 25-S (7/97)l of 2
#M6942
JMK (j) ACORD CORPORATION 1988
08/11/00 FRI 14:56 [TX/RX NO 7253]
Sent' by: J.A. Price
,~>..,. -
J
.... ," .."
.., .
.- :/:.:,,:;~:.,".
A..g:n?y.,,, ~nc.: . 9529440097; 08/11/2000
. ..... ........... ..... ...... e"'~"""='''''-'>''''''''''~~_..'''''''"~~_.'''_. e
4:22PM; #434; Page 7/7
IMPORTANT
If the certificate holder is an AOOlnONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rigrrts to the certifiCate hOlder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions oOhe poliCY, certain policies may
require an endorsement. A statement on this certificate does not confer rightS to trle 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 ins()rer(s), authorized represemative or producer, and the certlflCflte holder, nor does it
affirmatively or negatively amend, eXlend or atter the coverage afforded by the policies listed thereon.
ACORD2!i-S(7/97)2 of 2 ttM6942
::. ':'::~':':;", >..... . - - .
08/11/00
FRI 14:56
[TX/RX NO 7253]