2003-07-21 Insurance
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CUSTOMER NO. 0110099964
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1900 SOUTH 18TH A VENUE. WEST BEND, WI 53095
R 108
POLICY NUMBER: CPO 0314201 03
ENDORSEMENT EFFECTIVE JULY 21, 2003
ADDING LOC 5 TO GL; ADDITIONAL INSUREDS AND CG2012
COMMERCIAL GENERAL LIABILITY ADDITIONAL INTEREST
CITY OF ALBERTVILLE
5975 MAIN AVE NE, PO BOX 9
ALBERTVILLE, MN 55301
FORM CG2012
APPLIES
STATE OR POLITICAL SUBD PERMTS
ADDITIONAL INSURED
HAS BEEN ADDED
INSURED: LEUER-MUNSTERTEIGER
PROPERTIES, INC
100 E CENTRAL PO BOX 340
ST MICHAEL, MN 55376
AGENCY: ZACHMAN INSURANCE AGENCY INC
22-565
POLICY PERIOD FROM: MAY 08, 2003 TO: MAY 08, 2004
ISSUED 07/31/03
ADDL INTEREST COPY
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COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -
STATE OR POLITICAL SUBDIVISIONS - PERMITS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
State or Political Subdivision:
Section II - Who Is An Insured is amended to in-
clude as an insured any state or political subdivision
shown in the Schedule, subject to the following pro-
visions:
2.
This insurance does not apply to:
a. "Bodily injury," "property damage," or
"personal and advertising injury" arising
out of operations performed for the state
or municipality; or
b. "Bodily injury" or "property damage" in-
cluded within the "products-completed op-
erations hazard."
1. This insurance applies only with respect to op-
erations performed by you or on your behalf for
which the state or political subdivision has is-
sued a permit.
(If no entry appears above, information required to complete this endorsement will be shown in the Declara-
tions as applicable to this endorsement.)
CG 20 12 07 98
Copyright, Insurance Services Office, Inc., 1997