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Damage Due to Blasting <br />Damage Due to Collapse <br />Damage Due to Underground Facilities <br />Broad Form Property Damage <br />AUTOMOBILE LIABILITY: <br />Policy No. <br />Effective Date: <br />Insurance Company: <br />(X) Any Auto <br />LIMITS: [Minimum] <br />Bodily Injury: <br />$500,000 each person <br />Property Damage: <br />$500,000 each occurrence <br />no <br />Combined Single Limit Policy <br />YES <br />YES <br />YES <br />YES <br />Expiration Date: <br />$1,000,000 each occurrence <br />$1,000,000 each occurrence <br />ARE ANY DEDUCTIBLES APPLICABLE TO BODILY INJURY OR PROPERTY <br />DAMAGE ON ANY OF THE ABOVE COVERAGES: <br />If so, list: <br />Amount: $ <br />[Not to exceed $1,000] <br />SHOULD ANY OF THE ABOVE -DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL MAIL TEN (10) <br />DAYS WRITTEN NOTICE TO THE PARTIES TO WHOM THIS CERTIFICATE IS <br />ISSUED. <br />Dated at <br />• <br />On <br />Authorized Insurance Representative <br />Version 08/20/2021 for Council packet Page 27 <br />