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2855 Eagandale Blvd - Workmans Comp LiabilityOFFICE USE ONLY BUILDING PERMIT SUBTYPE ? 01 Foundation ? 26 Public Facility ? 30 Accessory Bldg. ? 14 Apartments ?27 Commercial/lndustrial ? 32 Ext Alt - Apts. ? 15 Lodging O 28 Greenhouse ? 34 Ext Ait - Comm. ? 25 Miscellaneous ? 29 Antennae ? 35 Ext Alt - PF WORK TYPE ? 31 New ? 34 Repair ? 37 Demolish Bldg. ? 43 Reroof ? 32 Addition ? 35 Tenant Impr ? 38 Demolish (Interior) ? 44 Siding 33 )< Alterations ? 36 Move Bldg. 0 42 Demolish (Found) ? 45 Fire Repair , ? 46 Windows/Doors GENERAL INFORMA.?2 Census Code SF,C Ccds No. of Units v No. of Bldgs. Const. (Actual) r? (Allowable) "[?•. UBCOccupancy 63 Zoning * ufi S'[ories Length Width Basement sq. ft. First Floor sq. ft. sq. ft. MISCELLANEOUS INSPECTIONS ? Gas Service Test ? Heating APPROVALS Planning Building ? Z- I I sq.ft. sq. ft. sq. ft. sq.ft. MC/ES System City Water Fire Sprinklered ? ? Insulation ? Plumbing ? Stucco/5tone Engineering Variance cr2. VALUATION:$ eO /5o)G Permit Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply 8 Storage S/W Permit S/W Surcharge Treatment Plant Park Dedication Trails Dedication Water Quality Other Copies % SAC SAC Units Meter Size 4 ; Total L.l?•?? R???4?.CE?l?' 1 zS?S`c????lUd ? CERTIFiCATE OF INSURANCE - WORKMEN'S COMPENSATION & LIABILI'iY ONLY This certifitate is nsued as a mattcr nl inlonnalion only dnd c(infCrs nt) riyhcs upon the certificate holder. This certificate doesnotamend, ex[end or alter [he coveraye afforded 6y the policies listecl below. Project Owner iott Auto Supply 5 Pilot Knob Road ation Eagandale Slvd., Eagan, Mn. Mn. Architect/Engineer ??ru v.v __ Address?yuu aerxes evenue nou[n,npls.,mn.»4 Agent COBB ST???13, DU;IPHY A.9ll ZIPMEILMANN Address 400 Builders Exchange, Mpls. Mn.554 WORKMEN'S COMPENSATION: PolicY- No t?C_6 ?+??r? Effective 7-1-80 Expiration 7-1-81 Insurance Company CONTINENTAL CASUALTY COMYANY Address CHICAGO, ILLI\OIS Coverage - Workmen's Compensation, Statutory. Employer's Liabili ty Limit $ 100, 000. each accident PUBLIC LIABILITY: Policy No. Cf.P 74375Fi$ Eftective 7-1-80 Expiration 7-1-81 Insura^ceCompany-Cf&'Sj.,yF?:1?±T ('dSi!A7TY rmrnativ Address CHTCAGn TT. TSNOTS Type of Ppliey: OComprehensive ?Other LIMITS: Bodily Injury $_7 . OQ 000. Each Occurrence Property Damage $ 250,000. Each Occurrence $1,0110.0 Il0 - A99regate $ 500 000. Aggregate' " Personal Injury $ t, nnn, 00(1 Aggregate COVERAGE PROVIDED (Check Applicable Square): OOerations of Contracmr . Operations of SubContractor (contingent) Does Personal Injury include claims rela[ed to employmrnt? Completed Onerations/Products Contractual Liebility (broad form) Exceptions: AUTOMOBILE IIABILITV -OR- _ Com bined Single limit $ Each Occurrence _ Yes No - Yes No ID ? Governmental Immunity is waived FL] ? 3 ? Properry Damage liability includes: .. Oamage due to blasting ID ? 13 ? Damage due to collapse FLI ? 0 ? Damage to underground facilities cl ? [a ? _ -. Broad Porm Property damage 1-1 ? PolicY No. RItA 8301026L__ E(fective 7-1-80 _ Expiration 7-1-81 insurance Company CONT NFN A AS(jALTY--C0MPANY Address CHICAGO, ILLINOIS Typa of Poliey: (OCamprehensive ?Other - LIMITS: Bodily Injury: $ Each Person - - OR - -- $ Eath Occurrence Combined Single limi[ $ 9(1(1, f10(1. Each Ocwrrence Property Damage S Each Occurrence Coverage is provided for operation of all owned, hired and non-owned vehicles Yes No E) 0 UMBitELLA EXCESS IIABILITY INCLUDING AUTOMOBILE LIABILITY: Policy No. Etfective Expiration Insurance Company Address LIMITS: Sinqle Liml[ Budily Injury -` and Propr.rty Damage $ _ Each Occurrence COVERAGE PROVIDED: Applies in excess of the coverages listed above for EmploYer's Liability, Pu61ic Liability Yes No and Automobile Liabiliry 0 0 Are any deductibles applitable to bodily injury or property ciemage on any of the above coverages? If so, list. ? El AGENT CARRIES ERRORS AND OMISSIONS INSURANCE " El ? Should any of the above described policies be cancelled before the expiration date thereof, the issuing compa will endeavor to mail fifteen days written notir.e to the beiow named certificate holder, but failure to maii such notice shall im no obligation or liability of any kind upon the company. Dated at *+p1s - ht' on 6-27-80 gy" ? Auihorized Insurance Representative ' J:... . ... CoMbuctinn Intlustry Coaperative Committee ol Minnesola - form GI.QC.401. Feb. 1961, Re.. June 1969, Rav. Jan. 7971, Fe.. Nov. 1977 L /I Ii °4i F°t?` ' ? / 11. ' CERTIFICATE OF INSURANCE - WORKh9Ef'"S COMPENSATION & LIABILI TY ONLY This certificate is issucd as a mancr nl information only and cunfers nti riyhis upon the certificate holder. This certificate does not amend, extend or aiter the coveraye alforded by ihe policies listeci below. , ??7? Project Landscaping at Elliott Auto Supply Locaunn -'???a1e__Blud Eagan, Mn. Owner CITY OF EAGAN, 3795 Pilot Knob Road, Eagan, Mn. Contrector Architect/Engineer _ Agent COBB. STRLCKER,_DUNPHY A;VD ZIAfMB[L'`1AA1N WORKMEN'S COMPENSATION 00 Suuth,1,1n1s.,Mn. Policy No 6?5- Etfective 7-1-80 Expiration 7'1-81 Insurance Company COATINliNTAL CASGALTY CO?7YANY Address CI[ICAGO, ILLINOIS Coveroge - Workmen's Compensation, S[aturory. Employer's Liability Limit 5 100, 000. each accident PUBLIC LIABILITY: PolicyNO. C.('P 7437568 Effective 7-1-80 Expiration_.]-1-81 InSUrar.c: Comaany--CIQgIIjQG\TM. !'AS(;ALT\' !'(1NiPACY Address CHTCAGO TT i T".OTS Type of Poliey: OComprehensive ?Other UMITS: Bodily Injury $ 1,M0 000. Each Occurrence $ 1 onn oon. n99rc9dtc Personallnjury $1,(M,nnn Aggregate COVERAGE PFOVIDED (Check Applicable Syuare): Opera[ions of Contractor Operations of SubConiractor (contingent) Does Personal Injury include claims related to employment? Completed Onerations!Products Contractual Lia6ility (broad form) Exceptions: AUTOMOBILE LIABILITY Property Damage $ 250, 000. Each Occurrence $ 500.000. Aggiegate - OR - Com bined Single Limit $ Each Occurrence Yes Na - Yes No ?x ? Governmental Immunity is waived El ? ID ? Property Damage liability includes: Damage due ro blasting El ? ? ? Damage due to collapse El ? 11 ? Damage ro underground facilities 0 ? ID ? Broad Form Property damage - 0 ? PolicV No. R IA 01024 Effective 7-1-80 _ Expiration 7-1-81 Insurance Company _GONTIVENTAI,CA$jLA[,TY-OMPANY Address CHICAGO, ILLINOIS Type of Policy: CDComprehensive ?Other _ LIMITS: Bodity Injury! $ . Each Person - OR - $Ear.hOcwrrence CombinedSingleLimitS 500,000_ EachOccurrence Property Dama9e S Each Occurrence - Yes No Coverage is provided for operation of all owned, hired and nonowned vehicles ID 0 UM6RELLA EXCESS LIABILITY INCLUOING AUTOMOBILE LIABILITY Policy No. Etfective ExpiraUOn InSUrance Company Address LIMITS: . ' Sinqle Limit Bodily InIurY and ProUPrty Damage S _ fach Occmience COVERAGE PROVIDED: Applies in excess of the coverages listed above for EmploYer's Liability, Puhlic Liability Yes No and Automobile Liability . . ? ? Are any deductibles appiica6le to bodily injury or properry dsmage onany of the above coverages? If so, list. . ? El AGENT CARRIES ERRORS.AND OMISSIONS INSURANCE ' El ? Should any of the above described policies be cancelled before Ihe expiration date thereof, the itsuing compa will endeavor to mail fifteen days written notice m the below named certificate holder, but failure m mail such notice shall im no obligation or liability ot any kind upon the company. - Datedat M{iq , Minn on 6-27-80 . gy Authorized Insurance flepresentative Consiruction Induslry CooperaU" Commlttee of Minnesola - Form C.I.C.C.701. Feb. 1961. Rev June 1969, Rev. Jxm. 1971, Rev. NoJ. 1977 CERTIFICATE OF INSURANCE - WORKMEN'S COMPENSATION & LIABILITY ONLY This certilicate is issued as a mattcr nl information onlv and confers no rights upon the certificate holder. This cortificata doesnotamend, extend or alter Ihe coverage afiorded by the policies listed below. Project Landscaping at Elliott Auto Suppl Location 2855 Eagandale B1vd.,Eagan,MN Owner CITY OF EAGAN, 3830 Pilot Knob Road, Eagan, MN 55122 Contractor Architect/Engineer Apent_rnuu CTRF!'KFR y)uNpH,v amn 7TMMFRMANA AddressP.O.Box_2750.i.non Sta Mols *iN 554? WORKMEN'S COMPENSATION: Policy No.sr 2317629 Effective 19-1-89 Expiraiion 12-1-86 InsUraoCe Comp2nyTRANSPORTATTf1N TNSIiRANC'F ('O Address CHICAGD.ILLINOS Coverege - Workmen's Compenzation, Statutory. Employer's Liabiliry Limit $ 100 000 - earh accident PUBLIC LIABILITY: Policy No. ('f P 9166714 Effective 12-1-85 ExDirotion 12-1-86 Insurence Company AMFRTCdN (`ASj1Ai TV rnrrnaNV AddressCHICAGO. T.. NOT Type of Po!icy: E]Ccmprehensive ?Other . LIMITS: 8odilylnjury $ 502,OC1R EachOccurrence S_10,000_ Aggregate Personallnjury g snn,nnn Aggregate Properiy Oamage $ 750 000 _ Each Occurrence g snn Of)0- Aggregate -OR - Combined Single Limit $ Each Occurrence COVERAGE PROVIDED (Check Applicable Spuare): Yes Operations of Contraccor 13 Operations of Sub-Contractor (contingent) 13 Does Personal injury include claims related to employment? (3 Completed Operations/Productf 13 Contractual Lia6ility (broad form) 13 No ? Yes No Governmental immunity is waived ' El ? ? Property Damage liability includes: Damage due to blasting Q ? ? Damaga due to cotlapse . Q ? ? Oamage to undergraund facilities Q ? ? Broad Form Property damage • Q ? Exceptions: AUTOM081LE LIABILITY Policy No. Rne 7i rr,7377 Effective 1 7-1-RS Expiration 12-1-86 insurance Company nMFgICAN CASUALTV rnM-Poh^' Address CHTCAGO. 7LLINOIS fYpeafPolicy: Comprehensive ?Other LIMITS: Bodily Injury: $ Each Person - OR - $Each Occurrence . Combined Singte Limit $ 500, 000 Each Occurrence PropertY Damage $Each Occurrence Coverege is provided for operation ot all owned, hired and nan•owned vehicles Yes No ? ? UMBRELLA EXCESS LIABILITY INCLUDING AUTOMOBILE LIABILITY: PolicyNo. irnrn 7166736 Effective 72-1-8 Expiration 12-1-86 Insnrance Company CnNTTNFNTAT ('ASTTA7 TY ('OMPANY Address CHICAGO. ZLLINOIS LIMITS: . Single Limit Bodily Injury and Properiy Damage $ 5 f1f1n n0n Each Occurrence COVERAGE PROV IDED: Applies in excess of the rnverages listed above for Employet's Liability, Public Liability Yes No and Automobile Liability El 11 Are any deductibles applicable to bodily injury ar property dema9e on any o} the above coverages7 If so, list. ? El AGENT CARRIES ERRORS AND OMISSIONS INSURANCE ' m 1:1 Should any ot the above descri6ed policies he cancelled before the expiration data thereof, the issuing company vri11 IrAlgRpNARXnail fifteea days written notice ro the Emtmecnamed certificate holder, R7dOC?AdxtAftOC1?C]?OR}{ORR . ?n ?? l? s? .. ? ? ? :?tiiV Dated at- MPls MN on 7-1-86 By ????--?-??j? ' Authorized Insurance Representative Comtruction Induitry Coope.auve Commite" ol Minneiow - Porm C.I.C.C.J01, feb. 1981, Rav. June 1969, Rw. Jsn. 1871, Rw. Nov. 1977