2005-05-24 Insurance Cert.
Jt..
SEH
TRANSMITTAL
To: Larry Kruse
City of Albertville
SEH File No.:
Client No.:
Re: 2004 Prairie Run Improvements, Albertville, MN
We are:
12I Enclosing 0 Sending under separate cover
1 - Renewed Certificate of Insurance, expires 02/01/06
For your:
12I Information/Records
o Action
Remarks:
For your files.
o Review and comment
o Distribution
By: Jodi Wroblewski
Date:
May 24, 2005
A-ALBEV 0409 7
N/A
o Sending as requested
o Approval
o Revision and resubmittal
c: Bob Moberg, SEH (w/enclosure)
Jim Schulz, SEH (w/enclosure)
Jmw
u:\a\albev\0409OO\corr\t-city renewed insurance-052305.doc
1/04
Short Elliott Hendrickson Inc., 1200 25th Avenue South, P.O. Box 1717, St. Cloud, MN 56302-1717
SEH is an equal opportunity employer I www.sehinc.comI320.229.4300 I 800.572.0617 I 320.229.4301 fax
..
PRODUCER
ACORDTM CERTIFICATE OF LIABILITY INSURANCE
Klein Agency, Inc.
3570 N L~xington Ave Ste
St Paul, MN 55126-8058
6 1 44- 1
INSURED
206
Dennis Fehn Gravel & Excavating, Inc.
5050 Barthel Industrial Drive
PO Box 256
Albertville, MN 55301
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS Nt) RIGHTS UPON THE CERTIFICATE.
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
INSURER A:
INSURER B:
INSURER C:
INSURER D:
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 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~f~ TYPE OF INSURANCE POLICY NUMBER b%~I~YM~btmVE LIMITS
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE [i] OCCUR
A
60-054 350
GEN'L AGGREGATE LIMIT APPLIES PER:
j~8T LOC
AUTOMOBILE LIABILITY
X ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
A X HIRED AUTOS
NON-OWNED AUTOS
60.-054 350
GARAGE LIABILITY
ANY AUTO
EXCESS LIABILITY
X OCCUR D CLAIMS MADE
27-022 148
A DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
10465.210
B
OTHER
EACH OCCURRENCE $ 1
FIRE DAMAGE (Anyone fire) $
MED EXP (Anyone person) $
. 02/01/05 02/01/06 PERSONAL & ADV INJURY . $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
COMBINED SINGLE LIMIT
(Ea accident)
$
500,000
BODILY INJURY
(Per person)
$
02/01/05 02/01/0 6 BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
02/01/05 02/01/06
AUTO ONLY - EA ACCIDENT
OTHER THAN
AUTO ONLY:
EA ACC
AGG
EACH OCCURRENCE
AGGREGATE
02/01/05 02/01/06
DESCRIPTION OF OPERA TIONS/LOCA TIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re: 2004 Prairie Run, SEH No. A-Albev 0409
The City of Albertville, its agents and employees, SEH, their officers and
employees, Dean Johnson Construction, Inc., their officers and employees, are
named as additional insureds per the endorsement attached to the policy.
CERTIFICATE HOLDER
ADDITIONAL INSURED; INSURER LETTER:
City of Albertville
5975 Main Ave.
Albertville, MN 55301
ACORD 25-$ (7/97)
CANCELLATION
S'a11d arf/ Of .. .. . .... . ba IIB.teI:ially
~, ~d:d, t:t ~:~~tha expiJ"l'.\tirT} ~
&te ~,cr fail tote ~.qx:n.tteir ~,
t:ba issui.n:J Y.lt~W will nail 3). days ];ria: wri.tten
~
@ACORDCORPORATION1988