1997-10-23 Cert of Insurance
OCT-24-97 FR I 13: 13 MEYER-ROHL IN, I NC_
612 682 9492
P.02
-...-_.:...-...:.~-)-"
ACORD CERTIFICAT
___,.."......~_ ~_""'.""" lfv'
F liABILITY INSURA.. E i~~TEOl o~~li;;,~~___
THIS CERTIfiCATE IS ISSUED AS ^ MATTER OF INFORMA liON
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
CO~!,~~IES A~FORo.lt!-G CQYER~~~_ ___._..__.
fROPUCEfl
Pierce Agency, Inc.
P.O. Box 418
l.itchfield MN 55355
David W. Pierce, eIC
.!~~'1~.UL_ ~_~.9 - ~2.~:: .~JJ.~_. ._.f~_~,-
I!ISURED
COMPANY
A
U.S.F.&G.
. ..._~--_._-----_.... "'...... ... ------
_v-.---------o-.-..----.-.-- . .,........._. ____,_"0___.. .'.
COMPANY
B
state Fund Mutual
_______..--.____..___".v.~..,___ ___._______,..-.-------
LaTour Construction, Inc.
2134 Co. Road 8 NW
Maple Lake MN 55358
---...-.------
cOVERAGES
THIS IS TO CERTIFY THAT THE POLlCll:S OF INSURANCE LISTED BElOW HAVE BEEN ISSUED TO THE INsunED ~JAMED ABOVE Fon TIlE l'uLlCY PEAlOD
INDICATED, NOTwrlllSTANDING ANY REQUIREMENT. rERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTifiCATE MAY BE ISSUED Of! MAY PERTAIN, THE INSURANCE AfFORDED BY THE POLICIES DEsclt$tO HEREIN IS SUBJECT TO All THE TERMS.
EXCLUSIONS AND CONDITIONS or- SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
~,o ~~~NY _.,
COMPANY
o
..,...__.._________.___... u_____._.____...
CO
LTR
lYPE Of It
----- ....' .-..........---. . --...---.,.- POLlCY NVM:--"--~~ E;;~T;; -- .,.------.--.- .... -.--.----......., .-- ...-.-
ISUAANCf POLICY EXPIRATIOI{ liMITS
, DATEIMMIOO/VYI DAn ,MWDDNY\
- -
I GF.NERAL AGGREGA n: ..~. ~ I C1Q~
___0-0'.-..-'''.--------...
ClfN1:RAL LlAOIl! TY IMP300222626-03 OS/28/97 OS/28/98 FRODUCTS . COMFIOP AGG ..~~.~..Q~..Q.!.
[~ OCCUR .,.,..-.----.----.
ADE peRSONAL e.. ADV INJURY ~_.l_!.Oq..Q.L
_._-- ---..-..,-..-
m'FlACTOR'S I'ROT EACI-lOCCURRENCE .$__~ r_ ~_Q.Q.I.-
---.-....--....------..
.....~...__. ..--..".'''-.' riflE DAMAGE (1)111 on~ I1rol .~_.'m.'~~~!.
-. .---.
MEO EXI' {Anv on. pe~onl :$ 5,
liT'(
OS/28/97 OS/28/98 COMIiINEO SINGLE liMIT S 1,000,
1MP300222626-03
-----'......------.. ..,.....--.-- - .......-
UTOS eODILY INJURY
5
UTOS (PH 1'01">On)
.--.-.,----- . ....-..-. .. ---,- -_._._.'~._--
BOOllY INJURY $
VTOS (Per .ccjd~nt)
.w,......_____w__.__._____..._ - .... ... ...-.-.
..-....-- .. _. ------- PROPERTY OAMAGE $
AUro ONLY. tA ACCtDENT $
- _......_,._.._.._ ___ _.___..___..._.._n,_._ .----.-...-..........
OTHER THAN AUTO ONLY:
--..----- ---.. . ,. ., . -....-.-.-...........-.....-
-----_. EACI-l ACCIDENT $
_n...'....."........."...,._.'---"._~-". _..- ._ _...__._u._.......
-'-'--- AGGREGATE S
EACH OCCVIlRENCF. 5 2 f 9l?l?_L
.....'.. ..- .---.-....-....-..----.- ---..--
RM IMP300222626-03 OS/28/97 OS/28/98 AGGAEGATE . ~..2...'_Q!?gL
______..'.." ...._.... _____..w.w..
UMBRELLA FORM $
-.-........-- x.l we ST~U. . []~~~. -----.
SAllOH AND
ITY .__ T9(j:U..LlIli. __. _EL .. __...____.._,.w_..
F=l ;:lL El EACH ACCIDENT ~_ !l? l?,.. 29..
00089.210 ___........,_.._.w.__...__'_._______
IVE OS/28/97 OS/28/98 EL OISEASE . POLICY LIMIT .!_~<!.~ oq
.-..,-..,.-.-.-.-.
El DISEASE - EA EMPLOY(E S 100,00
I
ion Covg. IMP300222626-03 OS/28/97 OS/28/98 50,000
---..-.-..,---..-
.L!!~p
000
000
000
000
000
000
GENERAl. lIAllll.ll'f
A X COMMF.nCIAL
_, :--.:J clAIMS M
OWNER'S a. CO
AUTOMOBilE lIA81
A X ANY AuTO
ALL OWNED A
SCHWULED A
X HIRED AUTOS
X NON.OWNED A
GARAGE LIABIliTY
"'-l ANY AUTO
-j -----..-.----
----
000
000
EXCESS LIABILITY
A _:l~~~~~~;NO
WORKERS COMPEN
CMPLOYERS'lIABIL
B THE;. ~ROPl'lIETOP.{
PAflTNEnS/EXECUT
B OFFICERS ARE:
OTHER
o
o
-.--..
o
A Installat
DESCRIPTION Of OPERA1tor~SlLOCATlONSNEHICLESlSPECIAlITEMS
Workers Compensation P91icy limit applies to accident a.nd disease. Should
any of th~ abQve polic+6s o6.changea, suspended or cancelled Qr fail to be
renewed, ~sBuinq 90, w11l lIIa1l 30 4&Y8 wr1tten notice to certificate holder.
Also named as aad1t1onal insureds ~n regards to 1997 parkside 4th Addition I
See attached list.
CfRl-II:ICATE HaiDER --'-
CANCEllA liON
PILOTLA
SHOULD ANY OF THE AlaVI! DESCRleED POLICIES IE CANCELLED BEfORE THE
O:P1MTIOIl DATE TliERfOF. THE .SSUIHQ COMPANY Will ENDEAvOIl TO MAIL
_~ DAYS WRITTEII HOTlCE 1"0 THE CERTIfICATe HOLDER NAMED TO THE LEft,
~~~~xor~MlK&roClKfUtfllQ0:}j8lM6ll!'l1t
2OPYStIY.Kftl: ~llNt'W<<.)tXiO aEHIG
AUTHORIZED REPRESENTATIVE
Pilot Land Development, Inc.
13736 HE Johnson st.
Ram Lake MN 55304
AC~ Z5.S (11951
David W. Pierce, eIC
~~~!(
<:gl ACOFiD CORPORArlON t988
OCT-24-97 FR I 13: 14 MEYER-ROHL IN, I NC.
-' e
612 682 9492
P.G3
e
Additional insureds in regards to 1997 Parks ide 4th Addition ~n
certificate issued 10-23-97:
Meyer Rohlin, Inc.
1111 Hwy. 25 N.
Buffalo, MN 55313
The City of Albertville
5975 Main Ave. NE
Albertville, MN 55301-0131
SEH
113 S. Fifth Ave.
PO Box 1717
St.Cloud, MN 56302-1717