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2002-05-30 LaTour Certificate of Liability Insurance=SEN TRANSMITTAL 1200 25th Avenue South, P.O. Box 1717, St. Cloud, MN 56302-1717 ro: City of Albertville 320.229.4300 800.572.0617 320.229.4301 FAX May 29, 2002 Date A-ALBEV 0113 14 File Number and Location Client Number RE: 2002 Northwest Commercial Park, Albertville, Minnesota We are ® Enclosing ^ Sending Under Separate Cover ^ As Requested 1 Certificate of Insurance, 05/22/02 1 Insurance Binder (RR), 05/14/02 1 Commercial General Liability Policy For your ® Information/Records ^ Action REMARKS: For your files. sY• Debbie Gilyard djg W:\albev\0113\corr\T-city insurance-052902.doc ^ Review ^ Distribution ^ Approval ^ Revision and resubmittal aioo Short Elliott Hendrickson Inc. Offices located throughout the Upper Midwest Equal Opportunity Employer IV a taelpyou ylrcn, rtc;~i~n~, mrd acftteve ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) t,p, TTE01 05/30/02 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Pierce Agency, Inc . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P . O. Box 418 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Litchfield MN 55355 Phone: 320-693-6115 Fax: 320-693-3452 I INSURERS AFFORDING COVERAGE INSURED ~ INSURERA: Western National Mutual ! INSURER B LaTour Construction, Inc • ~ INSURER C: 2134 Co. Road 8 NW ~ Maple Lake MN 55358 INSURERD: ! INSURER E: 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 DESCRIBE D HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR', LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE ~ POLICY EXPIRATION DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS 'GENERAL LIABILITY ~ ! !EACH OCCURRENCE ~ 5 1, OOO, OOO A XrOMMERCIAL GENERAL LIABILITY j CP3000O1494 O5/2$/O2 O5 /28/O3 FIRE DAMAGE (Any one fire) $ 5Q, 000 CLAIMS MADE '.~ X I OCCUR I. ~ I i MED EXP (Any one person) $ 5 , OOO A X!Includes X,C,U I CP300001494 ~ ~ 05/28/02 ~ 05/28/03 PERSONAL&ADVINJURY s 1,000, 000 X RR Protective Lial CP300006269 ~ 05/06/02 05/04/03 I GENERALAGGREGATE S 2,000,000 . GEN'L AGGREGATE LIMITAPPUES PER: ,~ ~ PRODUCTS -COMP/OP AGG (5 2 , OOO, OOO ~ ' :POLICY '' ~'., JECOT h...• LOC ~I ~ i AUTOMOBILE LIABILITY ~' ~ ~ COMBINED SINGLE LIMIT A ' X ANY AUTO CA300001912 05/28/02 ~ 05/28/03 (Ea accident) 151,000,000 '^ ALL OWNED AUTOS ': - ~ ~ ' ,BODILY INJURY 5 ' SCHEDULED AUTOS ~ ~: ~: 1 (Per person) ' X .HIRED AUTOS ' X 'NON-OWNED AUTOS I BODILY INJURY ! $ ~ (Per accident) PROPERTY DAMAGE $ i (Per accident) ii GgRAGE LIABILITY i AUTO ONLY - EA ACCIDENT $ ' I ANY AUTO 1 i ~, ' j $ ~ OTHERTHAN EA ACC 1 i AUTO ONLY: AGG ~ $ 'EXCESS LIABILITY_ ~ EACH OCCURRENCE ~ $ 2, OOO, OOO A OCCUR _', CLAIMS MADE ~ CU300000697 05/28/02 i 05/28/03 ~ A RGG EGATE $ 2 ~ OOQ ~ OOO 'S ~. ~, DEDUCTIBLE ~ $ 'RETENTION S i 5 'WORKERS COMPENSATION AND ~ ' ~ TORY LIMITS ~ i ER ~'i EMPLOYERS LIABILITY A WC300001126 05/28/02 05/28/03 i E.L.EACHACCIDENT ; $ 500,000 ~ E.L. DISEASE - EA EMPLOYEE , S 500, OOO I ~ E.L. DISEASE -POLICY LIMIT $ 500, 000 OTHER ; A ',Install/Blders Ris '~ IM300001850 ~ 05/28/021 05/28/031 50,000 A Rented Equipment ! IM300001850 ~ 05/28/02 05/28/03, 100,000 DESCRIPTION OF OPERATIONS/LOCA1'IONSNEHICLES)EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate holder is named as additional insured as well as SEH, PO $ax 1717, St. Cloud, MN 55302 and RLK Kousisto in regards to 2002 NW Commercial-. Park. ... _: - CERTIFICATE HOLDER ' y ': ADDITIONAL INSURED; INSURER LETTER: CANCELLATION °- - _- "Should any laf the abava A~srrila~d ~,ulicias~U;~,tt~ri~tlly cfiani, suspenA~A, ~r t;ilnGUICr,1 hU~ort~ the ~x~Irnaian dace rhar~of, or fail try b~ - City of Albertville t'ti~naweA upon their axZ,irnfign, tha issuln~ ~otTtpiuty wiU. mail ~Q dzlys prior 5975 Main Ave. NE PO Box 9 wriuan nr,tice to Ihc: numccl rrrt.i~~ats hul r." Albertville MN 55301 - AUTHORIZED REPRESENTATIVE David W. Pierce CI ~a ACORD 25-S (7/97) ©ACOR^ CORPORATION 1988