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2021-09-22 CC Packet
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2021-09-22 CC Packet
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9/17/2021 6:15:03 PM
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9/17/2021 6:14:49 PM
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<br />C <br />CERTIFICATE OF INSURANCE <br /> <br /> <br />PROJECT: <br /> <br />CERTIFICATE HOLDER: City of Centerville <br /> 1880 Main Street <br /> Centerville, MN 55038 <br /> <br />INSURED: <br />ADDITIONAL INSURED: City of Centerville <br />AGENT: <br /> <br />Policy No. __________________ <br />Effective Date: ______________ Expiration Date: _____________ <br />Insurance Company: <br />COVERAGE - <br />GENERAL LIABILITY: <br />Policy No. __________________ <br />Effective Date: ______________ Expiration Date: _____________ <br />Insurance Company: <br />( ) Claims Made ( ) Occurrence <br />LIMITS: \[Minimum\] <br />Bodily Injury and Death: <br /> $500,000 for one person $1,000,000 for each occurrence <br />Property Damage: <br /> $200,000 for each occurrence <br />-OR- <br /> <br />Combination Single Limit Policy $1,000,000 or more <br /> <br />COVERAGE PROVIDED: <br />Operations of Contractor: YES <br /> <br />Operations of Sub-Contractor (Contingent): YES <br /> <br />Does Personal Injury Include Claims Related to Employment? YES <br /> <br />Completed Operations/Products: YES <br /> <br />Contractual Liability (Broad Form): YES <br /> <br />Governmental Immunity is Waived: YES <br /> <br />Property Damage Liability Includes: <br />Version 09/17/2021 Page 25 <br /> <br />
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