Laserfiche WebLink
COVERAGE PROVIDED <br /> Operations of Contractor: Yes No Government Immunity is Waived Yes No <br /> Operations of Sub-Contractor(Contingent): Yes No Property Damage Liability Includes <br /> Does Personal Injury Include Damage Due to Blasting Yes No <br /> Claims Related to Employment: Yes No _ Damage Due to Collapse Yes No <br /> Completed Operations/Products: Yes No Damage To Underground Facilities Yes No <br /> Contractual Liability(Broad Form): Yes No Broad Form Property Damage Yes No <br /> EXCEPTIONS: <br /> AUTOMOBILE LIABILITY <br /> POLICY# EFFECTIVE DATE: / / EXPIRATION DATE: / / <br /> INSURANCE COMPANY: <br /> ()Any Auto ()All Owned Autos ()Scheduled Autos <br /> ()Hired Autos ()Non-Owned Autos <br /> LIMITS: <br /> Bodily Injury $ Each Person/$ Each Occurrence OR Combined Single Limit$ <br /> Property Damage$ Each Occurrence <br /> UMBRELLA EXCESS LIABILITY <br /> POLICY# EFFECTIVE DATE: / / EXPIRATION DATE: / / <br /> INSURANCE COMPANY <br /> LIMITS: Single Limit Bodily Injury and Property Damage <br /> $ Each Occurrence $ Aggregate <br /> COVERAGE PROVIDED; <br /> Applies in excess of the coverages listed above for Employers'Liability,General Liability,and Automobile Liability: <br /> Yes No <br /> Are any deductibles applicable to bodily injury or property damage on any of the above coverages? <br /> Yes No If So,List Amount$ <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 will <br /> mail 30 days notice to the parties to whom this certificate is issued. <br /> Dated at: On: By: <br /> MN License# <br /> Authorized Insurance Representative <br /> 180976 6/22/15 mpg 20 <br />