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<br />EXHIBIT "C" <br />TO SUBDIVISION AGREEMENT <br />CERTIFICATE OF INSURANCE <br /> <br />PROJECT: <br /> <br />CERTIFICATE HOLDER: City ofCenterville <br />1880 Main Street <br />Centerville, Minnesota 55038 <br /> <br />INSURED: <br />ADDmONAL INSURED: City of Centerville <br />AGENT: <br />WORKERS' COMPENSATION: <br />Policy No. <br />E:ffective Date: Expiration Date: <br />Insurance Company: <br />COVERAGE - Workers' Compensation, Statutory. <br />GENERAL LIABILITY: <br />Policy No. <br />E:ffective 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 />$500,000 for each occurrence <br />-OR- <br /> <br />Combination Single Limit Policy <br /> <br />$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 />Hanzal Development Agreement v91.docHIlll>W Develof)ffieat f.greemeat ...98 <br /> <br />24 <br />