2008-04-04 Cert of Liability Insurance
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
4/4/2008
PRODUCER (651)457-3070 FAX: (651)457-3324 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Minnesota Insurance Brokers, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
60 Marie Ave East Suite 209 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
West St. Paul MN 55118-5932 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: General Casual ty
No rthdale Construction Co. Inc INSURER B:
9760 71st Street NE INSURER c:
INSURER D:
Albertville MN 55301 INSURER E:
~OV
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 BFFN REDUCED BY PAID CLAIMS.
INSR ADD'L TYPE OF INSURANCE POLICY NUMBER P~k+~~~~~gg,wF Pgk!fiI~~,b~~N LIMITS
GENERAL LIABILITY EACH OCCURRENr.E $- 1,000,000
- ~~~~~~J?E~~~J~~nc"\
X COMMERCIAL GENERAL LIABILITY $ 300,000
A I CLAIMS MADE ~ OCCUR CCI0529921 3/31/2008 3/31/2009 MED EXP (Anv one nerson\ $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
~'LAGGREGATE LIMIT A@ESPER: PRODUCTS-COM~OPAGG $ 2,000,000
. [Xl PRO-
POLICY X JECT X LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
r-- (Ea accident) $
X ANY AUTO
I-- 3/31/2009
A ALL OWNED AUTOS CBA0529920 3/31/2008 BODILY INJURY
- (Per person) $
- SCHEDULED AUTOS
X HIRED AUTOS BODILY INJURY
- (Per accident) $
X NON-OWNED AUTOS
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
=1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY Ill"'"'''''' $ 5,000,000
~ OCCUR D CLAIMS MADE AGGREGATE $ 5,000,000
$
A ~ DEDUCTIBLE CCU0529918 3/31/2008 3/31/2009 $
X RETENTION 'I: 10,000 $
A WORKERS COMPENSATION AND X I WC STATU- I OJ~-
EMPLOYERS' LIABILITY 500,000
ANY PROPRIETOR/PARTNERlEXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? CWC0529919 3/31/2008 3/31/2009 E.L. DISEASE - EA EMPLOYEE $ 500,000
II yes, describe under 500,000
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS/LOCATlONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Project: Phillip Morris Lift Station, Albertville, MN.
City of Albertville and Bolton & Menk Inc. 7533 Sunwood Dr. #206, Ramsey, MN 55303 are listed as Additional Insureds,
with respects to General Liability coverage as required by a written agreement.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Albertville EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
5875 Main Ave. NE 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
Albertville, MN 55301 -
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER,ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ~ _-c::~ <""-
M Broderson/FRACHA ~~.
ACORD 25 (2001108)
INS025 (0108).08a
@ ACORD CORPORATION 1988
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