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2001-04-13 Insurance Certificate ACORDw CERTIFIC OF LIABILITY INSU DATE (MMIDD/YY) 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 NCE PRODUCER J A PRICE AGENCY, INC. 6640 Shady Oak Road SUlte 500 Eden Pralrle, MN 55344 INSURED Kuechle Underground, Inc 20 Maln Street POBox 509 Klmball, MN 55353 COVERAGES INSURERS AFFORDING COVERAGE INSURER A Western Natlonal Mutual Insurance INSURER B INSURER C INSURER 0 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 1~1~ TYPE OF INSURANCE POLICY NUM BER ~kw(~r:fJlJJ~ PO~.rFY li..xrIRf'JJ~ LIMITS DA E MID I A GENERAL LIABILITY CP300001273 03/24/01 03/24/02 EACH OCCURRENCE $1.000 000 I--- 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 & ADV INJURY $1 000.000 GENERAL AGGREGATE $2 000,000 ~ ~'L AGGREGATE LIMIT APASPER PRODUCTS COMP/OP AGG $2 000,000 X POLICY n ~~gT LOC A ~TOMOBILE LIABILITY CA300001536 03/24/01 03/24/02 COMBINED SINGLE LIMIT $1,000,000 II ANY AUTO (Ea accident) ~ ALL OWNED AUTOS BODIL Y INJURY $ SCHEDULED AUTOS (Per person) ~ ~ HIRED AUTOS BODIL Y INJURY $ Jl NON OWNED AUTOS (Per accident) I--- 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 [KJ OCCUR D CLAIMS MADE AGGREGATE $2 . 000 , 0 0 0 $ I:;] DEDUCTIBLE $ X RETENTION $10 , 000 $ WORKERS COMPENSATION AND IT"Xg~m~~~ I IO~~- EMPLOYERS' LIABILITY E L EACH ACCIDENT $ E L DISEASE-EAEMPLOYEE $ E L DISEASE-POLlC~ LIMI $ A OTHER Inland IM300001558 03/24/01 03/24/02 100,000/For Each Marlne- Jobslte Locatlon Installatlon Floater DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certlflcate holder has been added to the general llablllty POllCY as an addltlonal lnsured as per the Addltlonal Insured - Owners, Lessees or Contractors - Automatlc Status When Requlred ln Constructlon Agreement Wlth You endorsement Also named as Addltlonal Insured on the general (See Attached Descrlptlons) CERTIFICATE HOLDER I I ADDmONALINSURED INSURERLETTER: CANCELLATION SHOULDANYOFTHEABOVEDE~BEDPOLlCESBECANCELLEDBEFORETHE~RATION SEH RCM DATE THEREOF THE ISSUING INSURER WILL EN DEAVORTO MAIL3....0..- DAYS WRITTEN 1200 25th Avenue South NOTICETOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUTFAILURE TO DO SO SHALL P 0 Box 1717 IMPOSE NO OBLIGATION OR LIABILITY OF ANYKIND UPON THE INSURER,ITSAGENTS OR Salnt Cloud, MN 56302-1717 REPRESENTATIVES AUTHORIZED REPRESE~TIVE I Clt.n.... ,:tt.l.J ^ n r'\..RIU ~ ACORD 25-S (7/97)1 of 3 #M8119 JMK @ ACORD CORPORATION 1988 DES-qIPTIONS (Continued from"'" ,ge 1) llablllty lS the Clty of Albertvllle RE. Albert Vlllas * REVISED CANCELLATION CLAUSE - Should any of the above descrlbed pollcles be materlally changed, suspended, or cancelled before the eXplratlon date thereof or fall to be renewed upon thelr eXplratlon, the lssulng company wlll mall 30 days prlor wrltten notlce to the named certlflcate holder AMS 25 3 (07/97) 3 of 3 #M8119 It e ~ IMPORTANT If the certificate holder IS an ADDITIONAL INSURED, the pollcY(les) must be endorsed A statement on this certificate does not confer nghts 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 nghts 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), authonzed 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(7/97)2 of 3 #M8119 ACORD", Cllent 14847 KUEUN CERTIFIC. OF LIABILITY INSUeNCE g~i(~~'/~i 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 SUlte 500 Eden Pralrle, MN 55344 INSURERS AFFORDING COVERAGE INSURERA Western Natlonal Mutual Insurance INSURED Kuechle Underground, Inc 20 Maln Street POBox 509 Klmball, MN 55353 COVERAGES 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 '~f~ TYPE OF INSURANCE POLICY NUMBER Pgk!fJ(~~r~J)~ P?'~VJ ~~~~AJJ~ LIMITS A GENERAL LIABILITY CP300001273 03/24/01 03/24/02 EACH OCCURRENCE $1 000.000 Xl COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire $100 000 I CLAIMS MADE[X] OCCUR ME D EXP (Anyone person) $5 000 rJPD Ded 1.000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2 000.000 GEN L AGGREGATE LIMIT APPLIES PER PRODUCTS COM PlOP AGG $2 000 000 Xl POLICyn ~~gT n LOC A AUTOMOBILE LIABILITY CA300001536 03/24/01 03/24/02 COMBINED SINGLE LIMIT $1,000,000 ~ X ANY AUTO (Ea accident) ~ ALL OWNED AUTOS BODIL Y INJURY ~ $ SCHEDULED AUTOS (Per person) ~ It HIRED AUTOS BODIL Y INJURY $ X NON OWNED AUTOS (Per accident) ~ - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONL Y EA ACCI DENT $ --=l 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 -::KJ OCCUR D CLAIMS MADE AGGREGATE $2 000 000 $ ~ DEDUCTIBLE $ X RETENTION $10 . 000 $ WORKERS COMPENSATION AND 1~~n~~~sl IOJ~- EMPLOYERS LIABILITY E L EACH ACCID~NT.__ L_~~ ~ _ I I I E L DISEASE EAEMPLOYEE $ E L DISEASE POLICY LIMI $ A OTHER Inland IM300001558 03/24/01 03/24/02 100,000/For Each Marlne- Jobslte Locatlon Installatlon Floater DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certlflcate holder has been added to the general llablllty POllCY as an addltlonal lnsured as per the Addltlonal Insured - Owners, Lessees or Contractors - Automatlc Status When Requlred ln Constructlon Agreement Wlth You endorsement Clty of Albertvllle also named Atldtt:r:onci'I - -~ ._~ - - - lS as (See Attached Descrlptlons) - CERTIFICATE HOLDER I I ADDmONALINSURED INSURER LETTER: CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCjLlJi.Q BIiFOAE ~~lilfIRATION SEH RCM DATETHEREOF,THE ISSUING INSURER WILLENDEAVO~TO MAIL3-0.- 9~~RITTEN 1200 25th Avenue South NOTICETOTHE CERTlFICATIE HOLDER NAMED TO THE LEFT, BUTFAILURE TO DO SO SHALL P 0 Box 1717 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINO UPON THE INSURER ITS AGENTS OR Salnt Cloud, MN 56302-1717 REPRESENTATIVES AUTHORIZED REPRESE~TIVE >- - - - ......_ ,......... _ r I c,,,. .ft,--, ^ ,.o~ v ACORD 2S-S (7/97)1 of 3 #M8119 JMK @ ACORD CORPORATION 1988 DE~ ':.1IPTIONS (Continued from 1ge 1) Insured on the general llablllty RE Albert Vlllas, Phase II SEH Flle #A-ALBEV 0012 14 * REVISED CANCELLATION CLAUSE - Should any of the above descrlbed pollcles be materlally changed, suspended, or cancelled before the eXplratlon date there of or fa2l to be renewed upon thelr eXplratlon, the lssulng company wlll mall 30 days prlor wrltten notlce to the named certlflcate holder AMS 25 3 (07/97) 3 of 3 #M8119 ~ , .. e 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 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(7/97)2 of 3 #M8119