2004-09-08 Insurance Cert.
~
SEH
TRANSMITTAL
To: Larry Kruse
City of Albertville
SEH File No.:
Client No.:
Re: 2004 Prairie Run Improvements, Albertville, MN
We are:
1:81 Enclosing
1 Certificate of Insurance, 08/24/04
For your:
1:81 Information/Records
o Action
Remarks:
For your files.
By: Debbie Gilyard
c: Bob Moberg, SEH (w/enclosure)
djg
u:lalalbevl040900lcorrlt -city insurance-090804.doc
o Sending under separate cover
o Review and comment
o Distribution
Date:
September 8, 2004
A-ALBEV 0409 7
N/A
o Sending as requested
o Approval
o Revision and resubmittal
1/04
Short Elliott Hendrickson Inc., 1200 25th Avenue South, P.O. Box 1717, SI. 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
HUu-~4-~~~4 11;~~
.- """'.....,. II ''''''1'''\'''' "'.
P,,01/01
~lein Agenoy, Inc.
3570 N Lexington ~ve Ste 206
St Paul, MN 55126-8058
L.'I"'\UII...II I II."QU~I~""&;;
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
. HOL.DER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY.THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
COVERAGES
THl: POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED,NAMeo ABOVE FOR,THE POLICY PERIOD INDlCATED..NOTWITHSTANDING
ANY Rl;QUIREMSNT, TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENT WITH RESPECT TO WHICH THIS CERTlACATe MAY BE ISSUED OR
MAY PERTAIN, THe INSURANCE AFFORDED SYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TeRMS, exCLUSIONS AND CONDITIONS O~ SUCH
POl.ICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REOUCED BY PAID CLAIMS.
IL fR TYPE OF INSURANCE POLICY NUMBER POUCYM'if1D
GENERAL LIABIUTY
COMMERCIAL GENEAAL LIABILIlY
CLAIMS MADE [i] OCCUR
PRODUCER ~
Dennis l"ebn Gra.vel &, Excava.t.ing,.. IIl.C,
5050 Barthel Industrial Drive
PO Box 256
Albertville, MN 55301
60-054 350
60-05.4 350'
GARAGE UABIUTY
ANY AUTO
EXCESS LIABILITY
OCCUR 0 ClAIMS MADE
27~022 148
A
DEDuCTIBLE
RETENTION $
WORKEiR5 COMPENSAllON AND
EMPLOYEFlS' L1ABIUlY '
10465.210
B
OTflER
INSURER A;
INSURER B:
INSURER c:
INSURER D;
INSURER E; ,
EO POUCY EXPlRAllON
DATE
uwrs
eACH OCCURRENCE S
FIRE DAMAqE (Anyone fire) $'
MED EXP (Arty OIJ~ pen;on) S
02/01/04 02/01/05 PERSONAl & ADI/ INJURY $
GENERAl. AGGREGATE $
PRODUCTS-COM~OPAGG $
COMBINED SINGLE UMIT $ 500,000
(Ea acc1llenl)
BODILY INJUlW $
(Per pen;on)
02/01/04 02/01/05 BODILY INJURY $
(per accident)
PROPERTY DAMAGE $
(P", al:Cident)
AlITO ONLY" EA ACCIDENT
OTHER 'THAN EA ACC
AlITO ONLY:
EACH OCCURReNCE
AGGREGATE
02/01/04 02/01/05
02/01/04 02/01/05
lJESCRlI7TlON OF OPERATIONSlt..OCAllONSIVEHICLESlEXCLUSIONS ADOEO BY ENDORSEiMI5NTISPECIAL PROVISIONS
Re; 2004 Prairie Run, SEll No. ,A-Albev 0409
The City of Albertvil~e, 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.
CERTlFICATE'HOLDER ,
ADDmONAL INSURED; INSURER LETTER:
City of Albertville
5~75 ~in Ave.
Albertville" MN 55301
ACORD 2S.s (7/97}
CANCELlATION
. '9'r.1Jld arTi Of t:t& ~ das:ibed p:1liciF be ~;tny I
chatr~:l, ~, cr t:maWd ~ tba ~~Hr'I'1 .:..
dp tlaeac, ex fail tD t2 terBB:l tp:n .tha!r ~~cn/i
tiE ~ ~ ~.~ 3J dIys p:Ur wt::itt::m !
€I ACORD CORPORATION 1988
TOTAL P. 01
08/24/04 TUE 11:52 [TX/RX NO 5371]