1999-09-15 Cert of Insurance
~.
e
.':Sai=lClll
e
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 9814
14
File Number and Location
Client Number
RE: 1998 Center Oaks 3rd Addition, Albertville, MN
Insurance
We are
. Enclosing
1 Certificate of Insurance
o Sending Under Separate Cover
o As Requested
For your
. Information/Records
o Action
o Distribution
o Approval
o Revision and Resubmittal
o Review
REMARKS:
An Alfinnative Action,
Equal Opportunity Employer
Debbie Gilyard
By
W :\albev\9814\corrlse 14a-99-t.wpd
2/99
.
,',
ACORD~,
A
_._----------_._---~- ~--~-_. ._-.-._-- ~_._~_.
-cE'RT'lflcAl'-ciF'LIABILITY INSUR4CE _~~~TEOl D^~;/~;;ft~_,_
'THIS CERTIFICATE IS ISSUED AS A MATTER OF INfORMA liON
ONLY AND CONFERS NO RIGHTS UPON THE CERTlrtCA TE
HOLDER. THis CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED 8Y T1iE POLICIES BELOW.
---------.----..-
cqrv'l.P.~f:Jl~S..A~fO~U?I~C3 C9VER_~()E 'h .
"fIUIHIC!:::.H
pierce Agency, Inc.
P.O. Box 418
Litchfield MN 55355
LaTour Construction,
2134 Co. Road 8 NW
Maple Lake MN 55358
. ."..-......,,,.".,..
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PH1IOD
INDICA 1m, NOTWITI-ISTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CEHlIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDrrlONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
1 - -.-
I COtv~ANY
mu' ul'~~;~';~;;;'--'-'- ...--
'B state Fund Mutual
I COMPANY
I:~ "_nn_ __ _ __Ic~i~- n_ un. n=:n_= nnn .. .. ..
CNA
David W. pierce, CIC
Pho". No. 3 2_9_- 6~ 3:-~ 115 Fax No 3 20-~.9 ~ :-3_4 !1Am_._._'_
It/SURlO
i
I
I
II co
lfR
.... r~E'~iiMZ~IA;lu;,v-_.---_.._-"'-_.'--'~~
I ---I
A X j C():~:I~,:~~::r~tt;~~:~~ '11077038B65
; O~mI'R's & CONTRACTO~'S PROT
i !-
I
I
. ,
_..._...___.~.. '--'-'--'._-'_.-~-----T--'--
i ,
! POLICY EffECTIVE IpOUCY EXPIRATION ; LIMITS
i DATE (MM/DD/YV) DATE (MM/DD/YY\ :
..- '-u----.'.-----.---C.. LG~~ER":L AGGR'EGATE--:T~~;Q()o-;-9 ~Q ~.~.
06/04/99 06/04/00 L~~~E'y'~T.~_:.~~~P/OPAG~.j 5.2, Q99 ,.00_0..
~~.R~?~.A..~.8o.:-.~V INJUi1Y .~ 1, QOO, Q.OO,_
I EACH OCCURRENCE i $ 1, OOQ,...OOO
ru~~~~!;::\;~:~~~-)'~i~ .:.5'~~'~~'6-
T-.....------' , ,--.-.------..
/ / I / / I COMBINED SINGLE LIMIT 1$ 1,000,000
06 04 99 I 06 04 00 L ____... .._ i
II Ii BODILY INJIJRY , $
{Per oerson) I
I . ...---..---- .-.-
i
I
!
I' BoelL Y I"IJ'JRY
(Per eccide"~)
L._.....__ ........
5
TYPE OF INSURANCE
POLICY NUMBER
! AUTOMOBILE LIABILln'
'A
X A~Y AlIfO
I ALL OWNED AUTOS
, SCHEDULED AUTOS
. -,
X I HIRED A,:TCS
;. ;
, X ' NON.OWNW AUTOS
I ..
I 1077038879
i
I i PROPERTY DAMAGE i $
:1- Ti ! .~lJ.~_O~:'.:!~A~~-~~~T J ~. --.' .~~
I ~~T~E~:~A~AUTO ONLY: I
. -Ioo";;':;.,,,"'--_.u. .. .,~___n__nn_-i---.J.;;;,,"occ:::=:;~; fu; 000, 000.
~I A i'. ~, "M'"'''' '0'. . 1077038882 06/04/" I 06/04/00 l ^"!""", . '~'.." .. .. !. ~ 2 , 000,5>00
"___II.,~:E~!!..~ FO~~_.._~.__---..-.__,___--_~--_- I ---.L~ IS
.. ! ' 'wc SiATU- '0TH I
~~P~~~~~~Ol~::I~~T'DN AND . i L_J:rPBY~IMITS I . LEB :L__, -----...,.~-- -
I! i I EL EACH ACCIDENT .~ $~_O~_( OOJL_.__. ..
~B.I:;~~t~;~:~~:i~~TIVE ;- .~INC.LI! 00089.315 . 0.&/28/9-9 j OS/28IooE~_~~~.~~::~~.~lc~~u~,~ JSSOO,OOO.
..._,...?~ERS ~!~._ _~_..~..~~c:-\. .____,________.....___.___________.____ .__~ EL DIS~~ EA EMFLOYEE 1$ 500,000
, OTHER. I!
I A Instal. Floater . 10.11038865 : 0.6/04/99 06/0.4/0.0 I
I A Rented Equipment : 10.71038865 ! 06/04/99 06/0.4/00 I
...,.. .i...-_ __....__._ _____._l_..______________~___ __L..
D~SCRIPTION OF OPERATIONS/lOCATIONSNEHICLES!SPECIAL ITEMS ..
Xhe Work~rs Compensation policy limit applies to accident and disease
[The Ce~t.fic.t~ Holder, SEH, ReM, Inc" and the C1....ty. o. f Albe~t. Ville. ar. e. named
as add~t~onal 1nsureds with regard to the Center Oaks Fourth Addn project
CER"nFICA'i:e 'HOl-DEll-' .. .... ...--,. ..--.... .". -. ___________.__d_...__..___ CANCELLATION -----...-...-.-----------------------.---.....
! CENTERO sHOULD ANY OF THE ....eOVE DEscnlllED POLICIES BE CMICELLED SEfaME THE
...;
I
.---T~~~-;-~;-'--.--
I ! ANY AUT'}
50,000
100,00.0
center Oaks Partnership, LLC
13736 NE Johnson st.
Ham Lake MN 55304
EXrlRATlON OATE THEREOF, THflSSUING COMPANY WilL MAil
10. n DAYS WRITTEN NOTICE TO THE CERTifiCATE HOLDER NAMED TO TilE LEFT.
X~Xi)(I~i(Qt~,*~I~~K ~q(Q(l)l)<<#lQ)( *~IXr* t(IX't}(