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<br />ACORD.. CERTIFICAT~ OF LIABILITY INSURANCE OP ID 1~ DATE (llM/DDIYYYY) <br />BtJRSCHV 04/26/07 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />RJF Agencies, Inc. Plymouth HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />6000 Nathan Lane N., Suite 400 ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. <br />Minneapolis MN 55442 <br />Phone: 763-746-8000 INSURERS AFFORDING COVERAGE NAlC. <br />INSURED INSURER A: Western National Insurance 15377 <br /> Burschville Construction CO INSURER B: Travelers Ins. Co. <br /> i&K s8en~l INSURER c: <br /> ax 7 3-~ 7-4266 <br /> PO Box 6 INSURER 0: <br /> Hanover MN 55341 <br /> INSURER E: <br /> <br />COVERAGES <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT. TERM OR CONDmON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDmONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR INSRt TYPE OF INSURANCE POUCY NUMBER ~lllM1lfDiWf DATE'IMMID~ LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000 <br /> - ~=~?~=nce) <br />A X X COMMERCIAL GENERAL LIABILITY CP300007926 05/01/07 05/01/08 $ 100.000 <br /> I CLAIMS MADE [jJ OCCUR MED EXP (Any one person) $ 5.000 <br /> ~ Blkt Addl Insd PERSONAL & ADV INJURY $ 1.000,000 <br /> X contractual liab GENERAL AGGREGATE $2,000,000 <br /> - <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> I POLICY Iil ~~8;: n LOC <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> - <br />A X ANY AUTO CA300008438 05/01/07 05/01/08 (Ea accident) <br /> - <br /> ALL OWNED AUTOS BODILY INJURY <br /> - $ <br /> SCHEDULED AUTOS (Per person) <br /> - I tECEIVEC <br /> HIRED AUTOS BODILY INJURY <br /> - $ <br /> NON-oWNED AUTOS (Per accident) <br /> - , PR 2 7 2007 .. <br /> - PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> =i ANY AUTO CE nERVILLE, iIlN OTHER THAN EAACC $ <br /> - AUTO ONLY: AGG $ <br /> EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $5,000,000 <br />A ~ OCCUR D CLAIMS MADE CU300003110 05/01/07 05/01/08 AGGREGATE $5,000.000 <br /> $ <br /> ~ DEDUCTIBLE $ <br /> X RETENTION $10.000 $ <br /> WORKERS COMPENSATION AND X [TORY LIMITS I I U ~~- <br />A EMPLOYERS' LIABILITY WC300003007 05/01/07 05/01/08 E.L. EACH ACCIDENT $100,000 <br />ANY PROPRIETORIPARTNERlEXECUTIVE <br /> OFFICER/MEMSER EXCLUDED? E.L DISEASE - EA EMPLOYEE $100,000 <br /> If ~e8. describe under E.L. DISEASE - POLICY LIMIT $ 500.000 <br /> S ECIAL PROVISIONS below <br /> OTHER <br />B Lease/Rented QT660411X8343 05/01/06 05/01/07 Leased 350,000 <br /> Equipment Deduct 1,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />Re: Baokage Road & 21st Ave Utility & Street Improvements project in <br />Centerville, Minnesota <br />Ci ty of Centerville and Bonestro, Rosene, ADderlik & Associates, <br />Inc. (engineer) areaadi fional "insured per-attached forms CG 2033 (07-04) <br />and CG 2037 07-04. <br /> <br />CERTIFICATE HOLDER <br /> <br />CANCELLATION <br /> <br />CITYOCE SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 80 SHALL <br />City ofCenterville IMPOSE NO OBUGATlON OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />1880 Main Street <br />Centerville MN 55038 REPRESENTATIVES. <br /> AUTM9~RE!~2A .' - <br /> ~- 1'i <br /> <br />ACORD 25 (2001108) <br /> <br />@)ACORD CORPORATION 1988 <br />