2008-09-02 Insurance
From:Brandon FaxlD:Casualty Assurance
Page 1 of 4
Date:912212008 03:35 PM Page: 1 of 4
ACORD.
CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
casualty Assurance,
PO Box 38
101 West 3rd st.
Cbaska MN 55318
Pbone:952-448-3800
INSURED
Inc
OP IDBEW DATE (MMlDDIYYYY)
NIEME-1 09/22/08
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
AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fax: 952-448-3304
INSURERS AFFORDING COVERAGE
Niemeyer Inc.;
Niemeyer Properties, LLC
DBA: Niemeyer Trailer Sales
7918 Troy Lane
Maple Grove MN 55311
COVERAGES
INSURER A
INSURER B:
INSURER C
INSURER D'
INSURER E:
owners Insurance Co an
Auto-owners Insurance Co
NAIC#
32700
18988
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
LTR NSRC TYPE OF INSURANCE POLICY NUMBER DATE (MM/DDfYY) DATE (MM/DDfYYl LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
-
A X X COMMERCIAL GENERAL LIABILITY 0867860608 03/01/08 03/01/09 u"'v"'..,,, $ 300,000
PREMISES (Ea occurence)
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 10,000
A ~ Builder's RiSk 0867860608 09/18/08 03/01/09 PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
Xl n PRO- nLOC
X POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $ 1,000,000
ANY AUTO 4667860602 03/01/08 03/01/09 (Ea accident)
-
A X ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
A X HIRED AUTOS BODILY INJURY
- $
X NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ 1,000,000
A ~ .ANY AUTO 4667860602 03/01/08 03/01/09 OTHER THAN EA ACC $
AUTO ONLY: AGG $ 1,000,000
EXCESSNMBRELLA LIABILITY EACH OCCURRENCE $ 1000000
B X ~ OCCUR D CLAIMS MADE 4667860601 03/01/08 03/01/09 AGGREGATE $ 1000000
$
==1 DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X I TORY LIMITS I IU~~
A EMPLOYERS' LIABILITY 0823616 03/01/08 03/01/09 $1,000,000
ANY PROPRIETORIPARTNER/EXECUTIVE EL EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $ 1,000,000
If yes, describe under EL DISEASE - POLICY LIMIT $ 1,000,000
SPECIAL PROVISIONS below
OTHER
A Property 0867860608 09/18/08 03/01/09 Building 1,000,000
Equp Brkd
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLI,JSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Landowner As Additional Insured.
Building Located at: 101 Karston Lane NE
AJ.bertville, MN 55301
Fax: 763-497-2599
CERTIFICATE HOLDER
CANCELLATION
City of AJ.bertville
Bridget
5959 Main Ave.
AJ.bertville MN 55301
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, T~E ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR L1ABILrrv OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Dan Greene
ACORD 25 (2001/08)
@ACORD CORPORATION 1988
From:Brandon FaxlD:Casualty Assurance
Page 2 of 4
Date:912212008 03:35 PM Page:2 of 4
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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.
ACORD 25 (2001/08)