1998-05-28 Cert of Insurance
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TRANSMITTAL
605 FRANKLIN AVENUE NE, P.O. BOX 51, ST. CLOUD, MN 56302-0051
320253-1000
800346-6138
320253-1002 FAX
TO:
Linda Goeb
September 15, 1999
Date
City of Albertville
A-ALBEV 9804
14
File Number and Location
Client Number
RE: 1997 Center Oaks 2nd Addition, Albertville, MN
Insurance
We are
. Enclosing
1 Certificate of Insurance
o Sending Under Separate Cover
o As Requested
For your
. Information/Records
o Review
o Approval
o Revision andResubmittal
o Action
o Distribution
REMARKS:
An Alfinnalive Action,
Equal Opportunity Employer
Debbie Gilyard
By
W:I.lbevI9804lcorrlse 14.-99-1. wpd
2/99
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TRANSMITTAL
605 FRANKLIN AVENUE NE, P.O. BOX 51, ST. CLOUD, MN 56302-0051
320253-1000
800346-6138
320253-1002 FAX
TO:
Linda Goeb
September 15, 1999
Date
City of Albertville
A-ALBEV 9804
14
File Number and Location
Client Number
RE: 1997 Center Oaks 2nd Addition, Albertville, MN
Insurance
We are
. Enclosing
1 Certificate of Insurance
o Sending Under Separate Cover
o As Requested
For your
. Information/Records
o Review
o Approval
o Action
o Distribution
o Revision andResubmittal
REMARKS:
An Affirmative Action,
Equal Opportunity Employer
Debbie Gilyard
By
W :1.lbevI9804Icorrlse 14..99.1. wpd
2/99
;Aet)lllae
CEI=l"J"IF=JQA.(jI7INSliJllltiI~E
DATE (MMIDD/YY)
OS/28/98
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
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
KUEUN
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PRODUCER
J. A. P~ICE AGENCY, INC.
7100 Shady Oak Road
Eden Prairie, MN 55344
COMPANY
ATravelers Grou
.INSURED
Kuechle Underground, Inc.
20 Main Street
P.O. Box 509 .
Kimball, MN 55353
COMPANY
B
COMPANY
C
COMPANY
o
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.
CO,
LTRI
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE OLlCY EXPIRATION
DATE (MM/DDIYY) DATE (MM/ODIYY)
03/24/98 03/24/99 GENEF'.ALAGGREG.UE 52 000 O_Q.O_
PRODUCTS-COMP/OP AGG $2 000 000
PERSONAL & ADV INJURY $1 000 000
EACH OCCURRENCE $1 000 000
FIRE DAMAGE (Anyone fire $100 000
ME D EXP (Anyone person $5 0 0 0
LIMITS
A GENERAL LIABILITY
j X pO~MERCIAL GENERAL LIABILlT
, CLAIMS MADE [::KJ OCCUR
WNER'S & CONTRACTOR'S PRO
DTC0327N8644IND
A ~OMOBlLE LIABILITY
~ ANY AUTO
~-J ALL OWNED AUTOS
, I
W SCHEDULED AUTOS
l~ HIRED AUTOS
JU NON-OWNED AUTOS
, i
; ,
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DT810327N8644TIL
03/24/98 03/24/99
COMBINED SINGLE LIMIT
51, 000 , 000
BODILY INJURY
(per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
$
QT660396X8500TIL
03/24/98,03/24/99
i
I
STATUTORY LIMITS
EACI;L~CCIDENJ5500. 000
DISEASE .POLICY LIMIT $500 000
DISEASE-EACH EMPLOYEE $500 000
Schedule on file with
Travelers Group
$500 Deductible
000 000
3~
I GARAGE LIABILITY
ANY AUTO
A EXCESS LIABILITY
X UMBRELLA FORM
OTHER THAN UMBRELLA FORM
A I WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
I
THE PROPRIETOR/ . --Ti INCL !
; PARTNERS/EXECUTIVE r-1 I
OFFICERS ARE: . EXCL!
A ,OTHER Contractors
~quipment Floater
I
!
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS
DTSMCUP327N8644TIL 03/24/98 03/24/99
AUTO ONL Y .EA ACCIDENT
OTHER THAN AUTO ONLY:
EACH ACCIDENT
AGGREGATE
EACH OCCURRENCE
AGGREGATE
Retention
DTKUB327N8644
03/24/98 03/24/99
RE: Center Oaks, 2nd Addition,
(See Attached Schedule.)
Street and utility improvements,
Center Oaks Partnership
13736 NE Johnson Street
Ham Lake, MN 55304
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
...3..0.- DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALLlMPOSE NO OBLIGATION OR LIABILITY
ITS AGENTS 0 REPRESENTATIVES.
Albertville, MN.
The Certificate Holder, Meyer-Rohlin, Inc., 1111 Highway 25 North,
Buffalo, MN 55313, The City of Albertville, 5975 Main Ave NE,
Albertville, MN and SEH, 113 S Fifth Avenue, P.O. Box 1717, St. Cloud, MN
56302-1717 are all named as Additional Insureds on the General Liability
as respects the above mentioned project.
* Should any of the above described policies be materially changed,
suspended, or cancelled before the expiration date thereof, or fail to be
renewed upon their expiration, the issuing company will mail 30 days
written notice to the named certificate holder.
*********************** REVISED CERTIFICATE *****************************