2815 Eagandale Blvd - Workmans Comp LiabilityG110
(Ed. 7-66)
, qP?`
Ihis ¢ntlursemr,nl Imma,i prl nl IPr pclirv b.n whn.h a!ldrJm?1. clfC[Irvn nr Ih., uii eptuin ddte nl IhC pGliCr mdCSS Oth?rwis¢ 51dtCd h¢re.in.
' llhc lollowinp iidunnalion is required ,nly whcn t'iis endmsemr.nt ic issucd Subscquotil lo DreDaratir,n o( poli[yJ
Lndoisempnl efledrve Fnhcy No. CCP 527527$ EnAnrsemenl No
NameA hnsured RAIJL''NlIORS'P COP.PORATION
Addihonal Premium E IriCl. _ Countersipned by
(Aulhorited kepresentalive) ,
Eri'rMrY & ZiM1LilMfiiih
INCORPOnATED
iha r,nAoiseinenl in!idihr, such inzwance as h aNoodrtl hy Ihe provicions ol ihe potir.y relating lp lhe IollOwing;
CUPdPRcNENSIVE GEPiERAL LIABILITY INSURANCE
MFlNUFACTURERS f,ND COiJTRACTORS LIA81LI7Y INSURANCE
OWNERS AND COYTRACTOR + PP.O'lECTIVE LIABILITY INSURANCE
OWNERS, LANDLORDS ANO TENANTS LIABILITY INSURANCE
ADMIQINAL INSURED :
(Slalebr Political Subdirisions-Permils)
It is agrend Ihal Ihn °Pr.non: liuurnd'prnuir.inn lnclutles as an insured nny slate or poldical su6divrsion ihereaf designated m ihe schedule below. su6jecl
? lo the lollnwing adAilmnal poovivnu-,:
L 1he im.uranr.r ippliex only Htlh resocd to uperabm;s perlorrned tzy or on beGalf of thc named insured for which thr, state or OoOlital su6drvision
has iSSUed a pcrrnOL '
2.The Insm;inae tlne5 nol,ipnly In hotlily Icjury nr prr.pcrty dama;;
(a) miting uu1 al npeiahnns pr.rtormed Inr Ihe slal,,. Gr mume(Valdy, or
' (6) included mUnn the eoinpleieJ operalions haearJ.
3. If Ihe Propaty fl;mimgo Lii6dily I:nvr,iaqe ?s unl oLhnoHisv nlforkA, such insunnce chall neveilheless aDUty mlh :espect lo oDerahons performed
. 6y or on behalf ol Ihe nameJ insured lur whic!i such permit has 6een issuetl suhlett lo lhe limds of habilily staled herein.
SL'HEDULE
Designalion of Stale or Political SuhAirision: Clty of Eagan
limits of Properly Damage Lialiilily
S 250, i)OO. each occurrence
S 500,000. aggregale
AnnualPrcinium E IriCl.? G110 (C0.166)
G110
(Ed.7-66)
Inis entlorsement lonna.i p;art nl Ihr pohry 1" w11101 atl,¢h?•??, effni;lrvr o:. ;h.? mcephun tlalr nf the po6q' unless otherwise slaled herein
(lhe IollowinP iidotmatimi is requued oniy when l9is enGorseinenl is issur.J suhscquent to preDaralion nf poiiry.)
Endoisemenl eltecliuc Poiii:y Nn. CCP $275278 Endorsemenl No.
Named Intured REIUENHORST COP1'ORf1TI0N . ? Additional Premium E IriCl. _ Countcrsign¢d 6y - (putho ied Hepresentative)
COG3-STP,ECXE.1-9URPHY & ZiMMERMAD
INCORPORATED
ihis endorsenienl lmihhr„a such ur.mnnce as is ailordpd hy the provicions of Ihe pohcy relztmg to Ihe following:
COIAPRcHEN51VE GEf+ERAI LIABILITY INSURANCE
MANUFACTURERS AfdD COtJ7RACTORS LIASiL17Y INSURANCE
OWNfRS AND CONTRACTORS Pi?O"fECTIVE LIABIIITY INSURANCE
OWNERS, LANDLORDS AND TENANTS LIABILITY INSURANCE
ADDI'I'IONAL IIVSURED
(State or Political Su6dirisions-Permils)
II is aqreed Itial the "I•r,r,mi: In,pured" piovisiun includes as an insured any stzlr or poldical subtlivisinn fhereo( designaled in the schedule below. subjecl .
(t lo"A N lo the following adddinnnl Prnvivnuc.
1. lhe in;urancc i)plies nnP; wilh respwr.l to apeiabcns perlurmed 1!y or on behalf of the named insured lor which the slate or poldical subdnision
has Issucd a permit 2, ihe msmnnrn tlnes nol :iVPly la hotlily irjury ur prc; r,rly dain?g:: -
(a) orising out ul npcwlinriS pcifnnn??d Inr ihe 51o0-. Gr mumGpahty. or
- ' (6) included wiRun ihn complcled opcrationrhaearA.
3. II ihe Fropmly Uamagr liaLdily Cmmra¢e s imt utherxae at(nid4 such ?nsurance shall nevmlheless aoVtY mlh iesDecl lo operahons perfOrmed
by or on behalf ul the named insure;l lor which such uermit has been issuetl wbjetl lo the limds ot habilily staled herein.
SCHEDULE
Oesignalion ol State or Political SubAivision:
City of Eagan
limits of Propcrty Oamaye l.iabilily
S 2$0, GOO. each nccurrence
S 500 ,OOO. aggregale
Ilnnual Prcmium $ IttCl.
^ G110 (Ed.7-6G)
F 1
; Llc=i4P>3,/
- CERTIFICATE OF INSURANCE - WORKMEN'S COMP[NSA7IUN & LIABIUTY ONLY.
Thii certificete is issued as a matv:r of information only and confers no rights upon the certiiicate holder. This certificate does not amend,
extend or alter the coverage afforded 6y the policies listed below. 2815 Edg3rid2.12 BZV(j.. ,Eag2TL, T''fCl
1279 Avalon Ave.,Eagan,MN
P,]ect Landscapisy at Avalon Center,Bldg.A,B & C Location 1275 Avalon Ave.,Eagan,Pgl
Owner CITY OF EAGAN 3795 Pilot Knob Rnad, Eagan, MN 55111
Contractor _
Architect/Enqineer__
Agen[ LV15D JILCCA;LCC,Ki 1JU1VYt1Y HNiJ L.ll"ll`1C.LiL`7HLVLV qddress 4VV 15ll114C'TS rXCCIc'iLlge, 1•1p15. l?llv )>,+Vt
WORKMEN'S COMPENSATION: Policy No. WC-T5454-= Effeciive 7-1-$1 Expiration 7-1-$2
? Insurance Company CnNTINENTAT ('ASiiAT TY Cl(TTPANY Address CHICA?9 IIS.INOIS
Coverage - Workmen's Compensation, Statutory. Employer's Liability Limit $ 100.000. each accident
PUBIIC LIABIIITV:
Policy No. CCP 527521$ Etfective 7-1-81 Expirotion 7-1-82
Insurance Company AMF'R7('.AN (:ASITAT.TV ('.fY?iP?[?]y Address ('.HT('A(',(l IT.i.INOIS
Type of Policy: lDComprehensive _ ?Other_
LtM17S:
8odily Injury $ L000 OOO_Each Occurrence Property Damage $?SQ_ OOO. Each Occurrente
$1,QQ0 ,000? Ag9regate
Personal injury $1..YQQQ,QQD,._Aggrega[e
COVERAGE PROVIDED (Cherk Applicable Square):
Yes
Operations of Contractnr ?
Operations of SubContractor (contingent) ?
Does Personal Injury include claims
related m employment? ?
Completed OperatlonSlProducts ?
Contractual Liability (broad form) ?
Exceptions:
AUTOMOBILE LIABILITY
$ 500.000. Aggregate
- 0 R --
Combi ned Single Limit $ Each Occunence
No Yes No
? Governmental Immunity is waived (D ?
? Properry Damage liability includes:
Damage due to blasting ED ?
? Damage due to collapse (z ?
? Damage to undergroond facilities 0 ?
? Broad - Form Property dama9e ? ?
PolicY Na BUA --- $04± Effective J-1-H^_ ExPiration 7-1-82
Insurance CompanY_ X9ERICAN GASUALTY CQ`1PANY Address CKICAGO ILLINOIS _
Type of Policy: ElComprehensive ?Other_
LIMITS
Bodily Injury: Each Person - OR -
$___--_Each Occmrence Combined Single Limit $ 500,000. _Each Occurrence Property Oamaye $____- _ Each Occurrence . Yes No
Coverage is provide.dfor operation of all owned, hired and non-owned vehicles N El
11M8flELLA EXCESS LIABILITY INCLUD ING AUTOMOBILE LIABI! ITV:
--
Policy No.____ _Effective_ Expira[ion
Insurance Company.___.__._____ _ Address
UMITS
Single Limit Rodily Injury
and ProPerty Damage $ Each Occurrence
Yes No
COVERAGE PROVIDED: Applies in excess of the coverages listed a6ove for Employer's Lia6ilitY, Puhlic Lia6ility
anA Aummobile Lia6ility ? ?
Are any deductibles applicable to bodily injury or property cfemage on any o( the above coverages? Ii so, list. ? ?
AGENT CARRIES [RRORS AND OMISSIONS INSl1RANCE E3 ?
Should any of the above described policies be cancelled before the expiration date thereof, the issuing co any wili endeavor to mail
fifteen days written notice ro the below named certiticate holder, but failure to mail such notice shal ? pose no obligat+on ov IiabUity oi
any k(nd upon the company.
Dated at__NP1a_._. MN on 6-30-81 gy ? ???'??'?-'-? _
?..,.., Authorized Insurance Represep,t?live
6.iih1L49Yt1n11`?
ConsVUCtion InH.srv ??nnri-.r;?,? f',..?.,,?i!•^^ ar ntinnom+, . F-m r I C.C..707. F=h 1PFl P?v Ivne 19fi_9-Ra7:lin7i1:471, Rev Nov. 1977
' G110
. .?? [ (Ed.1-66)
^ r, This endorsemenl lonns a p?it nl It,n pniirv tn whi,.h allached. e.lfecirvp oii IPr inceplinri date nf the policy unlesz olherwise stated herein.
(ihe lollawing inlunnalion is requirel nnly when this enAorscment is issucd suhsequent to preparation of policy )
Endorsemenl effeclivr. 7-1-82 Policy Nn.CCP 21$43$2 Endorsement No.
Named Insured REIIIIIVHORST CARPORATION ? '
- Additional Premium $ ?C?.. Cuuniersigned by ? ' r 'E"?'?'`Oa
(Aulhorieed Represenfative)
CnbB-STRECaER-QZDP1^f4Y 8? ZiMM?iifVih?iN
INCORPORATED
lhl; enrlorsemr,nl ninddl^.-, r.i!di ?ncn?,iue as is ilfnrd^A hy Ihr provisions nf ihe policy relating to thr following:
cor,nrr.EI1F.NS14E GEIdERAI LIABILITY INSURANCE
MANUFACTURERS RND CQCiTRACTORS LIASiLITY INSURANCE
OWNERS AtlD CqNTR!1CTOftS PROTECTIYE LIABILITY INl'iURANCE
OWNERS, LAFIDLORDS AND TENAN'iS LIABILITY INSURANCE
RDDITIQ«AL INSURED
(Slate or Polilical Su6dirisions-Permits)
Il is agrer.d tiial Ihe °Fer;ons Insu,rtl° I:iuvi^.inn ir.ciuAes as rn insured any state or paidical subdivision ihereof designaled in the schedule below, subject
eo'N t0 the followirg additional proviSionc.
1. the insurance applles nnly m!h re:pr.l lo rmnratinnc nerfonned I)y nr nn behalf o( the named insured for which the Slale or polltical Subdivlslon
has Issuvda pr.nnit. .
2. The inswance does nnt appiy In bodily :•;ery or pwrp^.rfy Aani?,c
(a) arisinq out of opniahons pcrfoimed Inr Ihc sLiL° or mumopality, of
' (b) induded within the tomp!e1^d epcraLons hazard.
1 II the Pwperty Uamzge Lla6illly Gnvr,raRe is nol otherwlse alinrtled. wr,h insurance shall nevertheless apply wllh respect to oDerations Derformed
. 6y or on behalf ot the named insured fnr whidi such pr.rmil has been issucA suhjed lo Ihe limits of liabilily stated herein. .
SCHEDULE
Designalion of Stale ar Polilical Suhdirision:
City of Eagan
Limits ot Pwperly Daniagc Liability _
S 250,000. r.achocarrence
S 500,000. aqgrrtgate
Rnnual Premium $ 111C1.
? G110 (Ed.7-66)
?CERTIFICATE OF INSURANCE - VJORISMEPJ'S COMFcNSATION & LIABILI iY ONLY
This cerirficate is issued as a mattr,r of lnforrnation only and confers nn rights upon the.certificate holder. This certilicate does notamend,
extend or alter the coverage aflorded by thc pollcies IisteJ below. 2815 Ea.gaIldale B1Vd.,E2gan,MN .
1279 Avalon Ave. ;Eagan,T'IIQ
Proiect TandGcaRing_at .9ya]g17-C2I1t2T B1dp,-A,B & C Locanon_1275 Avalon Ave. Ea?an.P?IlV
Owner ??Sx lil Uk
Contractor
Architett/Engineer
Agent COBB. SIRE(.'KER. DUNPHY f1M Z=RP'1ANN
WORKMEN'S COtv1PENSATION
ddress
Policy No.---WC-215_435.1? _[ffec?ive7-l-a2 Ezpiraiion 7-1-83
Insurance Company CONTIDIFNrAL CASUALTY CCfl_`1PAW Address_ CHICAGO. ILLINOIS
Coverage - Workmen's Compensation. Statutory. Empioyer's Liability Limit 100 , 000 each accident
PUBLIC LIABIUTW: Policy No. C-'CP-?154352 Effecuve_L7,-$2 Expiration 7-1-83
Insurance Company--MaINFNrAT. .AS1fAT.']„')L-C(1+jPALU- Address_ CHICf1G0 J,TiTS ,
Type of Poliey: ElCamprehensive ?Other__
LIMITS:
Bodily Iniury $?Q?QQQ?Ear,h Occurrence
$ i nn_?.tQQ?._Aygreqate
Personal Injury $ 1 nn.,0QQ?Aggre9ate
COVEHAGE PflOVIDED (Check Applicabie Squarel
Properry Damage . $_ 2_5(LOQO. Each Occurrence
g 500.000. Aggregate
-OR -
Combined Single Limit $ Each Occurrence
Yes No Yes No
Operations of Contractor . 0 ? Governmental Immuniry is waived ? ?
OperationsotSub -Contractor (conting=nt) ? ? Properry Damage liabllity includes:
Does Personal Injury include claims - Damage due to blasting. ? ?
rela[ed to employment? ? ? Damage due m collapse ? ?
Completed Onerations/Products ? ? Damage ro underground (acilities )13 ?
Contractual Liability (broad forml ? ? 6road Form ProF>erty damaqe ?0 ?
Exceptions: ' -
AUTOMOBILE LIAE3ILITY:
Policy No. 3 Effective_. 7-1-82 - Expiration 7'1-$3
Insurance Company__CONTINGNtAL CASlTALTY _l Address CHICAC'?0. ILLINOIS -
Type of Poliey: OComprehensive ?Q ther_ . _
LIMITS:
8odily Injury! $. _ Each Person - OH -
$ _ Eaoh Ocar.renc e Combin ed Single Limit $5Dil. Each Occu rrence
Property Damage S -_ -Each Occurrenc e
Yes No
Coverage is provided for operation oi all ownrd hlred a n(i nomo wned vehicles ' )0 cl
UMBRELLA EXCESS LIABILITY INCLUUING AUTOMOBILE LIABILITY: ?
VolicyNo. Fltcuive._
--
InSUranceCompany
._-.._.
LIMITS: - ? '
Single Limil Bodily Injury
and?ProperryDamage $ _ . __FachOccwrenirle . Yes No
COVERAGE PROVIDED: Applies ln encess o1 thp, coveiayes listed ahove toi Employer's Liability, Public Liability ?
and Automobilc Llabiliry ? ?
Are any deduttibles applic561e to bodlly lnjury nr properzv demage on any of the above coverages? Ii so, Ilst. , ? ?
AGENT CARflIES ERRORS AND OMISSIONS INSURANCE
Should any o( the above describecl pollr,Ies be cancelled hefore the e+piration da[e thereof, the issuing comp will endeavor to mail
fifteen days written notice to the P@QQ?name.d certifir,ate holder, but fadure to mail such notice shall ose no ohli ation or liabiliry of 0ny kind Upon Ihe company. . Datedat Mp1s?MN 6_28_32 --__- ?
o?,-- ??" -------- ----
r, C ?'r Authori'iedFlnsUra'`nce'RepieSe'nta[ive
. . , . .,. . .. ,
COn.t.....:,.i. ?..... r . _ ; .. .... ... . ?.. . ..,?. .I!`Ni"nY?hf\ 1- TCD1n11 n.. N..., tq77
. G110
q?, r (Ed.1-66)
This endoaemenl fonn; a p,i! nl D'r pnliry tn whi' 6, tiachCd. Cloctivo nn U!,-in;ephnn Jale of the pnlicy unless nlher•xise slalr.d herein.
fThe lollowing iiJornialian is require9 only when ihis endorscmenl is iss!ir.tl subsequent ln preparafion of palicy.)
Endnrsemenl effectivr, 7-1-82 Folicy Nn.CCP 2154352 - Endorsement No.
Named Insured RAUIIV[-IORST CORPORATION
- Additional Prr.mium E IriCl. Countersigned 6y 6Wr;0le`---? - (Authorited Representative)
WJ-SIdttC:Qi':,,1 ?' Zii;{i;'I!;S1Ii(•.,.
INCORFORATED
Ihi; endorsemenl ineddm; sedi m:min?e as is ilfor0d hy Ihr p.ovicimns nf Ihr, ppllry rplatinQ IO the fOIIOWing:
carnrr,:HF.NSIYE 6ENERAI LIABIIIiY INSURANCE
MANUFACTURERS RND CQP41R/4CTOR$ LIABiLITY INSURANCE
OWNERS ArID CONTRACTORS P`iOTECTIYE LIABILITV INSURANCE
ONJNERS, LnfdDL4RDS AND TENAtV'TS LIABILITY fNSURANCE
AQQITIQNAL INSURED
(Slale or Political Suhdirisions -Permils)
It is agrer,d tiiat Ihe "Per,ons Inwradprnvi<mn mr,luAes as an insured any sta[e or uulllical subdivi:ion thereof designaled in the schedule below, suhject
? IOIh¢ 1011Dwing ddd'Ilipnnl provislonr
1. The msurance applies ad? mth iee?'c'.I In nnerafin o? nerfonnrd by or on hrhalf of the named insured lor which the stale, or political subdivision
hds i;su^A a 0!,nniL . .
2. The insuranrc does not,ipply [o hrlN9 i";:rv or prnperly Aam^gn
(a) arlsing mit of opnrabons pcrl(,rrnrd loi ihe sint^ or muniupahty, m
(b) included withm the eoRplel^d epr.ralions hazard. -
3. II the Property Uamzge Liahllily Covr,rage is not olherwise aHordeA, such insurance shallneverlhelr.ss apply with respect to operations pertormed
by or on behaH of the named insured tor whlch such per.nit has hr.en issued subjed to the fimlis of IiablGty statetl herein. .
SCHEDULE
Designation of Slate or Polilical Sutrlivision: C1ty of Eagan
limitt of Pioparty Damap^ liability
S 2501 000. eachocuurrence
S 500,000. ?gg,egale
Annual Preminm s Incl.
il"?' G110 1166)
,?
- ?/!l ? ?? dr1G+?a?P
? RECEIVED JiJL
?CERTIFICATE OF INSURANCE - tNORKMEN'S COMFENSATIDN & LIABILI TY ONLY f 9982
This cer`tificate is issued as a matter oi information only and cnnfers no righ[s upon the certiticate hoider. This certificate doesnOtamend, extend or alter the coverage afiorded 6y the policies listed below. 2815 Edg3riCj310 BZV(j.. ,Eag2Tl,M ,
1279 Aualon Ave.,Eagan,PV
Proiect T=nrlacaninu ^t Av^1pn GeL1tPY_,Bidg.A B& C Location 1275 Avalon Ave. EamMN
Owner
Agent COBB. STRECKER. DLTNPHY L1ND ZII`II`9ERI'IAN[V
NSATION:
Policy No. WC L174571
Insurance Company CONrINENrAL CASUAI
Coverage - Workmen's Compensation, Statutory
PUBLIC LIABILITY
Efiective 7-1-82 Expiration 7-1-83
Employer's Liability Limit $ ZOO 000. each accident
voncv No. CCF 2154352 Etfective 7-1-82 Expiration 7-1-ti3
Insurance Company-=INFNrAL GA5iiE1I.TY CQkANY Address(-HI.SAM 1JLTWTs
Type af Policy: ElComprehensive DO[her
LIMITS:
8odily Injury $__1,D0Ha,OOO_Each Occurrence Properry Damaye $_ 250 000. Each Occurrence
$_],nnn,nnn Aggregate
Penonal Injury $-]..,0(JQ-,.D00 .,-Aggregate
COVERAGE PROVIDED (Check Applicable Squarel:
$ 500.000. Aggregate
-OR -
Comtiined Single Limit $ Each Occurrence
Yes No Yes No
Operations ot Contracto. 9 ? Govemmental Immunity is waived El ?
Operations of Sub-Contractor (contingent) pg- ? Properry Damage liabiliry includes:
Does Personal Injury include claims Damage due to blasting U ?
related to employment? Q ? Damage due to collapse c cl
Completed Operations/Products 50 ?- Damage to underground facilities ?
Contractual Liability (broad form) ? ? Broad Form Propeity damage ? ?
Exceptionr .
AUTOMOBILE LIABILITY:
bUA 4 3
i
7'1-82
7-1-83
Policy Na on
Expirat
Effective
InsuranceCompany CONTINGIVIAI, CASUALTP CCWANY qddress CHIC[1G0 ILLIN()IS -- -
TypeofPoliey: UlComprehensive 0Other __ __.-
LIMITS:
Bodily Injury: $ Each Person -OR -
$. Each Occurrence Com6in ed Single Limit $ 500,000. Each Occurrence
Property Damage $Each Ocr.urrence , Yes No
Coverage is provided for operation of all nwned, hired a nd nomo wned vehicles i] El
UMBFELLA EXCESS LIABILITV INCLUOING AUTOMOBiLE LIABILITY:
Policy No.
Insurance Company Addieu_
LIMITS
Single. Limit Bodily Injury
and Propr.rty Damage $
Each Or,currencc
COVERAGE PROVIDED: Applies in excess ot the r,overayes listed abovr for Employer's Liability, Pu61ic Lia6ility
and Automobile Liabiliry
Are any deductibles appliczble to bodiiy injury or property ciemage on eny of the above coverages? If So, list.
AGENT CARRIES ERROfiS AND OMISSIONS INSURANCE
Yes No
? ?
? ?
El ?
Should any of the above described policies be cancr.lled before the expiration date thereof, the issuing com will endeavor to mail
fi}teen days written notice to [he b2i3LkLnamed certificate holder, but tailure to mail sucH notice shall Tose no o/bligation or liability of
2ny kind upon the company. q J
Datedat Mpls.. MN oil 6-28-32 gy?
. CQB?i ?-sli
Con:tr?,?.:?..,., i,_?,,... ..? . . ... .. ......:?.. . ?.-,.. .. r _ ? ? .. r ,.?? . ?.. ?„c? ....
! a
n,-., N,,, 1977
Expiration
C[RiIFICAT E OF INSURANCE - WCRKME PJ'S CUN1P[NSA f IUN & UABIU iY ONLY
This r.erpifir,qle is issucl as a in:ilirr nf infnnna1lnn onlv and confers n,) rights opon the certiflctite holder. This certificate does not amend,
extciid or alter Lhe cnveriqe il(prd?d by Ihc policies iisipd i,eiow. 2815 Eagandale BZVCl. ,Eagan, .TfCl.
1279 Avalon Ave.,Eagan,MN
Proiecc Je?9?9pixk; at A_v_alon_.Center,Bl.d,_:A?B & C _Lor,t;,,,,_1275 Avalon Ave. an,r'IN
_
Owner CITY OF EAGAN, 3795_Pilot_Knob_Road'E-agan,_.P4N 551_11
-- - ----
Agent _ CQBB,_SZ'RE_CKEz,. I?UNPf[Y AND ?Il`TCMANN"Address 400 BuildersEacclange, Mpls. MN 5540:
WORKMEN'S COMPENSATION:
Policv No. -WC-7545425---.-___----_-___-_ E?rp?t?uP 7-1-81 Expiration 7-1-82
Insurance CompanY G-Q??UM&L.-CA.51MTY_CQ"R1ANY-_Address.?HIS',?#Gq ILL'INOIS
Coverage - Workmr.n's Compensation, Statutory. Employer's Liability Limit $_ 100,000. each accident
PUBIIC LIABILITY: ,
----
Policy No._CCP__5275278__-__._.._.__._._._._..-. Effective 7-1-8]„_ Expiration 7-1-32
Insurance Company___BMII2IC'.E1N-CASLIlALTY_CGT`7PANY Address (711TC1AGn TT.T.INOIS
Type of Policy: MComprehensive . ?Other__LIMITS!
Bodily Injury $.L,000,9Q0_Each Orcurrence Properry Damage $_250,000. Each Occurrence
$_Z QQQ,.0Q0?Aqgreqatr
Personal Injury $._1_,..00Q.,.QQ0- Aggregate
COVEHAGE PROVIDED (Check Applir,able Square):
6. Aggregate
- O R --
Combined Sin91e Limit $' Each Occurrence
YPS No Yes No
Operations of Contracv?r 91 ? Governmental Immunity is waived ? ?
Operations nf SubCmnhactor Icontin9end Ei ? Property Damage liabiliry includes: .
Does P^_rsonai Injury inr.lude claims pamagc due ro blasting ? ?
related to r,mplnymnnV . El ? . Damage due to collapse - ID ?
COmpleted Opniations/Pi(dur,ts 0 ? Damage to undelground facilities E) ?
Contractual Liability (broad (orrn) E) ? Rroad Form Properry damage El ?
Exceptions:
AUTOMOBILF LIA8ILITY:
---
licv No. Bt1A._88Z8F3504---------------
Po
---_
Erractive 7-1_31 _._ ExPi,atioo
7-1-
82
Insurance Company. _._?`71:RI('AI?I CASL1fALTP_CQAIPAIQY Addra.u_ CHICf1CO. ILI,INOIS
Type of Policy: OComprr,hensive. ?O[her___ __ .__-___.__-._--___
LIMI7S:
Bodily Injury? $__.___ f.arh Pr•rsnn -OR -
Gomhin ed Single Limit $ 5?s000__Each Occurr ence
ProperlY Damage $__....__....... Far.h Occune.nce Yes tJu
roveraqe k provii!r.J Iqt operaliun of all owneJ, iiircd and non-owned vehiclrS Q ?
UMBFiFLIA EXCESS LIABII.ITV INCWDING l1UTOMOBILELIABILITV:
- --- ---- .___ _._-._T..._.
Policy No___,.
InzuranceCompanV----_-. ___._..._..._.._
LIMITS:
Sinqln Lirnit Hodily-Lo jury.
and ProPcrly U:imagc $ Each Or,uirrrnrc
Yes No
COVERAGE PROVIDED: Applies in rxr.ess of lhe coveiaycs listed above for FmplOVer's Liability, Puhlic Liabili[y
and Automotrilc Liability ? ?
Are any dedur.tibles apnlir.able to hndilv it,juiy ur propeny rMmage on anv of the above coverages? If so, list. . ? [B
AGENTCARRIES ERROIIS AND OMISSIONS INSURANCE 0 ?
Should any o( the above dnscribed policies br r,ancclled befoie Ihn expirdtion date ihereoi, the issuiny rompan i'll endeavor [o mail
fifteen days wriuen notir,e tn the b?low named certificate holder, but ladure to mail such notice shall im no obligation or liability of
any kind upon the company - ?
Dated at 1?_? -??----------- o„ 6-30-81 g -
Mo- Y--------- -...-
. ?.Jj. , . JjAuthocized; Insuriance-Representative
COMburlinn In,1n• , .-,, C, .... ii ....., n+'.,,n?•??a G- /' I f C.701 F-I. 1nr,1 q... Inn? InF3_'.Rwi^?lin?llolt Anv No., 1977
G wq
0
CERTIFICATE OF INSURANCE - WORKMEN'S COMPENSATION & LfABiUTY ONLY
_ _ .._ - -------- --- --- i
This certificate is issued as a matter of in(ormation only and confers no rights upon t rficate holder. This certiticate doesnotamend,
extend or alter the coverage afforded by the policies listed below. .HZ.rJ ga11?7.12.BIVCj.. ,F2?,3T1, A?T
Avalon Ave., Eagan, MN
Controctor
?..? ---- --'--"'---'
Agent COBB, STRECfCER, DUNPHY AND ZII"INIQtI`1ANN Naaress .,, - .....r.,_?.., .W. .
AddressP.O.BOX 2150,Loop td. , Mpls. ,
WOiiKMEN'S COMPENSATION:
Policy No._ 7021 95 40 Etfective 7-1-84 ExPiration 7-1-$5
Insurance Company_PACIEIC: T1Vf1HMN7TY fflf)ANy Address LOS A?UELES. CAL7FORNIP,
Coverege - Workmen's Compensation. Statutory. Employer's Liahili ry Limit $ - ZOO..OOO. each accident
PUBLIC LIABILITV:
Policy No. . Ef(ective 7-1-84 Expiretion 7-1-85
Insurence Company_?'iBaT_MR17IW--TN.SIiBAI)CE (Lt1PAN Y Address I`4INNEAPOLIS, MN
Type o( Poliey: ElComprehensive ?Other
LIMITS:
Bodily Injury $ 1 ?0Q0,OOO. Each OcCUrrence
$ 1.0?0,1000. Agqre.gate
Personal Injury $. iTooQQ0.Q, Agyregate
COVERAGE PROVIDED (Ch.sck Applicahle Sqoare)
Operations of Contraciur
Operations of SubContractor Icontingentl
Does Personal Injury iriclude claims
related to employment?
Completed Operations/Products
Contractual Liability (broad form)
Exceptions:
AU70MOBILE LIABILITY
Properry Damage $ 250.000. Each Occurrence
$ 500,000. Aggregate -OR -
Comh ined Single Limit $ Each Occurrence
Yes Na Yes No
? ? Governmental Immunity is waived ? ?
? ? Property Damage liability includes:
Damage due to blasting g] ?
12 ? Damage due to collapse El ?
m ? Damage to underground facilities 91 ?
12 ? Broad Form Property damage ?] ?
oolicy No. 7307 34 95_ Etfective 7-1-84 Ex iration 7-1-8$
Insurance Company I1IGIIAIU_INSURANCE_?MPANY Address M14 `I??, NEw YO
Type of Policy: 13Comprehensive ?Other
LIMITS:
Bodily Injury: $ Each Person - pp - $. Each Occurrence Combined Single Limit $ 500.000. Each Occurrence
Property Damage $ _ Each Occurrence
Yes No
Coverage is provided for operation of all owned, hired and non-owned vehicles cl 0
UMBRELLA EXCESS LIABILITY INCLUDING AUTOMOBILE LIAOILITY:
Policy No. _. Effective Expiration
Insurance Company Address
LIMITS:
Single I_imil 6odily Injury
and Property Damage $_ . _._.._..,__ ____Each Occurrr.nce
Yes No
COVERAGE PROVIDED: Npplies in excess of the coverages listed above fvr Employer's Liability, Public Liability
and Automobile Liability 11 13
Are any deductibles applicable to 6odily injury or property clemage on any ot the above coverages? If so, list. ? El
AGENT CARHIES ERRORS AND OMISSIONS INSURANCE • El ?
Should any of the above described policies be cancelled betore the expiration date thereof, the issuing company will lli? mail
fifteen days writcen notice to thodq-tMnamed certificate holder.
Dated at Mols. , MN o„_ 6-27_34 ey d
. BB e ?13GHdh +rnv?F!N
Conatruction Industry Coope,auve Comminec nf Minn¢,ma - Fo.m C.i.C.C.701. Fen. 1961, Rev Ju e 1999CRevPJan"!1971, qe?. Nov. 1977