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From:Lisa To:Fax#9522494616 Date:5/13/03 Time:4:13:54 PM Page 1 of 3 <br /> ACOADL CERTIFICATE OF LIABILITY INSURANCE 05�i3M/M2 0 <br /> PRODUCER (507)665-3364 FAX (507)665-6510 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Handwerk Insy�rance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR <br /> 202 S. Main ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> P.O. Box 175 <br /> Le Sueur, MN 56058 INSURERS AFFORDING COVERAGE <br /> INSURED Bon Woll Drilling Co. INSURER A: Secura <br /> 16550 Baseline Ave. INSURER B: <br /> Shakopsle, MN 55379 INSURER C: <br /> I INSURER D: <br /> INSURER E: <br /> COVf:RAGES <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 CONDITION 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 CONDITIONS OF SUCH <br /> POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> MSSR POLICY EFFECTIVE POLICY EXPIRATION LIMITS <br /> TYPE OF INSURANCE POLICY NUMBER DATE MMIDD DATE MM/DD <br /> GENERAL LIABII-7 P-3043646-0 01/01/2003 01/01/2004 EACH OCCURRENCE $ 500,000 <br /> X COMMERCIqIL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ 100,0001 <br /> CLAIM$MADE M OCCUR MED EXP(Any one person) $ 10,0001 <br /> A I PERSONAL&ADV INJURY $ 500,00C <br /> GENERAL AGGREGATE $ 1,000,00C <br /> GEN'L AGGREGAI E LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 1,000,00( <br /> X POLICY JECaT LOC <br /> AUTOMOBILE LA BILITY 20-A-3043647-0 01/01/2003 01/01/2004 COMBINED SINGLE LIMIT <br /> X ANY AUTO (Ea accident) $ 500.000 <br /> ALL OWNED AUTOS BODILY INJURY <br /> SCHEDULE AUTOS (Per person) $ <br /> A <br /> HIRED AUTO BODILY INJURY $ <br /> NON•OWNE AUTOS (Per accident) <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILIl Y AUTO ONLY-EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA.ACC $ <br /> AUTO ONLY: AGO $ <br /> EXCE88 LIABIL 20-CU-3043649-0 01/01/2003 01/01/2004 EACH OCCURRENCE $ 2 000 00 <br /> X OCCUR CLAIMS MADE AGGREGATE $ 2,000,000 <br /> A $ <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS CO NBATION AND 20-WC-3043648-0 01/01/2003 01/01/2004X TOSTA -L <br /> RY LIMITS ER <br /> EMPLOYERS'L ILrrY E.L.EACH ACCIDENT $ 500,000 <br /> A E.L.DISEASE-EA EMPLOYEE $ 500,000 <br /> E.L.DISEASE-POLICY LIMIT TS 500,000 <br /> OTHER <br /> DESCRIPTION OF OPE TIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br /> CERTIFICATE HO DER ADDITIONAL INSURED:INSURER LETTER: CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL <br /> 10 DAYS WRrTTSN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br /> City of Orono BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY <br /> PO BOX 66 OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. <br /> Crystal Bay, MN 55323 AUTHORDED REPRESENTATIVE <br /> rLisa Lindeman <br /> ACORD 25-S(7/97) FAX: (9S2)249-4616 GACORD CORPORATION 1988 <br />