1999-09-15 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 9908 14
File Number and Location
Client Number
RE: 1999 Center Oaks 4th Addition, Albertville, MN
Insurance
We are
. Enclosing
1 Certificate of Insurance
D Sending Under Separate Cover
D As Requested
For your
. Information/Records
D Review
D Action
D Distribution
D Approval
GRevision and Resubmittal
REMARKS:
An Affinnatil'e Action,
Equal Opportunity Employer
Debbie Gilyard
By
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W :\albev\9908\corrlse 14.-99-1. wpd
2/99
~--ACORD~,
-cE'Ri'l F I cAl.-i)'i=' L lAB I LITY INS U RteC E "E~~::: .:.----;~(-;-!.;~~~;~~!-'-
____ 9.21.2!~?_._.
THIS CERTifICATE IS tSSUED 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
..__. .. - ._- _. .-
Hf-((llHIC(:H
pierce Agency, Inc.
P.O. Box 418
Litchfield MN 55355
LaTour Construction,
2134 Co. Road 8 NW
Maple Lake t~ 55358
Inc.
I COtv~ ANY
.- '--.m'.-r~;;~.;~;;Y-. 'n._ ....
'B state Fund Mutual
I C8MPANY
I._,~_.__,_____. m___.... n ___._..
.-.__,_,__--. __ _..__.I CO~~ANY
CNA
David W. pierce, CIC
Phon.N.... 32.Q~6~3:-~115 FaxN.. 320-g93-3.4~A.__..,
Ir/senm
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PH~IOD
INDICArm, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TflIS
CEHlIFlCATt MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCfllBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS Af~D CONDrTlONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
--. I - ---
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I CO
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..-_.~_.-_._---
i GErIERAL LIABILITY
I '--1
A X, COMMERCIAL GENERAL UAEILlTY
1 '.! CLAIMS MADE r x'! OCCUR I
: OWNER'S 8< CONTRACTOR'S PROT !
1 I
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1
TYPE OF INSURANCE
POLICY NUMBER
I
POLICY EFFECTNE POl.lCY EXPIRATION !
DATE (MMIDDNY) DATE IMM/ODNYI [
LIMITS
._..._.,.___~_.._..._.__.__.___..__-__-i-____
I .. _____ ___._._._....._......._......,
LGE~ER~LAGGREGATE . ~~_~, .Q()9 LQ~2_.
06/04/00 L~~~P..Y.,c~~.:_~2~P/OPA~ 15.2, Q()() ,.00f} ..
L!:~.R.~~~.A..~.&_~r:v '/ljJURY ] ~ 1,1 QOO, Q.OO,.
I EACH OCCURRENCE i s 1, OOQ,...POO
~~~~E~A~~9~_(~~~.o~e.!~~.) j s.~. .)i,o('o-O'O ..
T_.._________~ED EXP (Any one pers~.--,-.~ OO~__..
/ / 1/ / I COMBINED SINGLE LIMIT i $ 1,000,000
06 04 99 I 06 04 00 i ;
i ' '
I II BODILY INJ';RY I $
I {p6r oe,soe)
I I. .-
I I BODILY '''JURY
I I (Per tJcciden!)
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s
1077038865
06/04/99
'A
~ AUTOMOBILE L1ABILlTV
x.., A~Y AllfO
I ALL OWNED AUTOS
. SCHEDULED AUTOS
. - I
X I HIRED A,;TCS
i- :
I X ' NON-OWNeD AUTOS
! . I
1077038879
.. ; i i PROPERTY DAMAGE
______...-l_____._.,__ I i
!.G^..~GE LIABILITY r I !.~lJ.~.~~_'=~.:~~A.~c:'~~~T .: s
I ! ANY AUTO ,I ~~T~ER.T~A~"UTO O'~~~-
_ --t;-"----,----~------'-------L--J- - 'AO:~:?~';; t: -___
I f.XCESS LIABILITY' I I EACH OCCUR.RE~C.E L~.~-,O()O, ()OO
I A !~"'IV9PELLPORM 1077038882 ~ 06/04/991 06/04/00 LA~S;.~.~~I\~~..._...... ..!.5.2,000,.oOO
r I I .
'--lWO'R::~;:~:~:~~~~~:~~:~R~-..+__---..---_._---_._.---- I ---t-- I we STATU- I 10TH.: s --
EMPLOVERS LIABILITY i L.. .J:rP_RYUWTS I . LEE! ..!.---- -- -----...... ..... -
.~ $ s._oq_~ o~_q,,____.
~B i;~;;;i'.:;~;,~~n"' '~,..," i.' 000a!h315 OSl2S/99 ( 05/28/ooH~_~~CE~~~~~~~:~~I~I': !S500,OOO
..__.~~~~:RS ~!~__ _~'-:..~~~,L.t._._..,________._. ...__.________._,,_ j _ _\ EL DIS~~~ EMPLOVEE ] S 500,000'
I I
I:
is
Instal. Floater 1077038865 . 06/04/99 i
. Rented Equipment ; 1077038865 ! 06/04/99 I
..... 1...-_ ___..,_. .....i.._.._________,_____._L i
DESCRIPTION OF OPERATIONS/LOCATlONSNEHICLES!SPECIAL ITEMS
The Work~rs Compensation policy limit applies to accident and disease
The certJ.ficalt'i' Halder, SEH, ReM, Inc. and the City of Albertville are named
as additions J.nsureds with regard to the Center Oaks Fourth Addn project
06/04/00 I
06/04/00 i
50,000
100,000
L
CANC!:LLA TlON
CERTIFICATE HOLDER
,
CENTERO
sHOULD ANY Of THE AeOVE DEscm8ED POLICIES BE CMICELLED 8EfOKE THE
EXPIRATION OATE THEREOF. THE ISSUING COMMNY WILL MAIL
10.. DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TltE LEFT.
center Oaks PartnerBhip, LLC
13736 NE Johnson St.
Ham Lake MN 55304
David
!
~CORD 25.S (1/95)
......___.._...___.....-.-._....LO'.--...........----... .-_......._'"-.-'-____........_~"..._,_.......... -"-"_""_...-.--..-._...____._.--.
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