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COVERAGE PROVIDED <br /> Operations of Contractor: Yes '< No Government Immunity is Waived Yes No X <br /> Operations of Sub-Contractor(Contingent): YesNo _ Property Damage Liability Includes <br /> Does Personal Injury Include Damage Due to Blasting Yes X No <br /> Claims Related to Employment: Yes \ No Damage Due to Collapse Yes N No <br /> Completed Operations/Products: Yes X No Damage To Underground Facilities Yes h No <br /> Contractual Liability(Broad Form): Yes Ni No Broad Form Property Damage Yes X No <br /> EXCEPTIONS: <br /> AUTOMOBILE LIABILITY <br /> POLICY # (17014 5 1 H EFFECTIVE DATE:1( 11-/ EXPIRATION DATE: <br /> tk <br /> INSURANCE COMPANY: \J vk‘ h'r— <br /> ()Any Auto All Owned Autos ()Scheduled Autos <br /> (*Hired Autos Wlon-Owned Autos <br /> LIMITS: <br /> Bodily Injury $ 1 O Each Person/$j_kt.4 Each Occurrence OR Combined Single Limit <br /> Property Damage$ ( Each Occurrence <br /> UMBRELLA EXCESS LIABILITY <br /> POLICY# %o y c y ( 4EFFECTIVE DATE: i t I / EXPIRATION <br /> DATE: a I q- i t 9 <br /> INSURANCE COMPANY U <br /> LIMITS: Single Limit Bodily Injury and Property Damage <br /> $ ' .4-1 Each Occurrence $ �}--if1 Aggregate <br /> COVERAGE PROVIDED: <br /> Applies in excess of the coverages listed above for Employers'Liability,General Liability,and Automobile Liability: <br /> Yes jr\ No <br /> Are any deductibles applicable to bodily injury or property damage on any of the above coverages? <br /> Yes k No If So,List Amount$ 000 Cit. l, - (e <br /> AGENT CARRIES ERRORS AND OMISSIONS INSURANCE: Yes )( No <br /> Should any of the above described policies be cancelled before the expiration date thereof,the issuing company <br /> will mail 30 days notice to the parties to whom this certificate is issued. <br /> Dated at: k 1 ( On: By: vU. t"I. P{•irk.; S <br /> MN License# 2 o34,3z.. <br /> Authorized Insurance Representative <br /> 23 <br />