1993-07-19 Cert of Insurance
ANJIAN411
.' '
CBR
ISSUE DATE (MM/DD/YY)
07/19/93
PRODUCER
Pierce Agency, Inc.
P.O. Box 418
Litchfield MN 55355
COMPANIES AFFORDING COVERAGE
COMPANY A
LETTER
State Fund Mutual
INSURED
Annandale Contracting, Inc.
6646 County Rd. 5 NW
Annandale MN 55302
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MMIDD/YY)
LIMITS
OS/23/93
MED. EXPENSE (Anyone
COMBINED SINGLE
LIMIT
GENERAL AGGREGATE
OCCUR.
AUTOMOBILE LIABILITY
AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
EACH OCCURRENCE
AGGREGATE
A
WORKER'S COMPENSATION
AND
003994.103
STATUTORY LIMITS
A
EMPLOYERS' LIABILITY
003994.103
OS/23/93 OS/2
DISEASE-POLICY LIMIT
DISEASE EACH
OTHER
DESftl"t!IOW PItR~8'Wii>OC*~:'tmU/SPECIAL ITEMS
policy limit also applies to accident and disease.
City of Albertville
Albertville MN 55301
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL ~ DAYS WRITTEN NOTICE TO THE CERTI CATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE ALL IMPOSE NO OBLIGATION OR
LIABILITY ANY KIND UR N THE C' MPA ,ITS A ENTS OR REPRESENTATIVES.