11-28-2016 Council Packet - Laserfiche WebLink

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COVERAGE PROVIDED Operations of Contractor: Yes Operations of Sub -Contractor (Contingent): Yes, Does Personal Injury Include Property Damage Liability Includes Claims Related to Employment: Yes Completed Operations/Products: Yes, Contractual Liability (Broad Form): Yes EXCEPTIONS: Damage Due to Collapse No Government Immunity is Waived Yes No No Property Damage Liability Includes Damage Due to Blasting Yes No No Damage Due to Collapse Yes No No Damage To Underground Facilities Yes No No Broad Form Property Damage Yes No. AUTOMOBILE LIABILITY POLICY # EFFECTIVE DATE: / / EXPIRATION DATE: INSURANCE COMPANY: ( )Any Auto ( )All Owned Autos ( )Hired Autos ( )Non -Owned Autos LIMITS: ( )Scheduled Autos Bodily Injury $ Each Person / $ Each Occurrence OR Combined Single Limit $ Property Damage $ Each Occurrence UMBRELLA EXCESS LIABILITY POLICY # EFFECTIVE DATE:—/—/ EXPIRATION DATE: / INSURANCE COMPANY LIMITS: Single Limit Bodily Injury and Property Damage $ Each Occurrence $ Aggregate COVERAGE PROVIDED: Applies in excess of the coverages listed above for Employers' Liability, General Liability, and Automobile Liability: Yes No Are any deductibles applicable to bodily injury or property damage on any of the above coverages? Yes No If So, List Amount $ AGENT CARRIES ERRORS AND OMISSIONS INSURANCE: Yes No Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will mail 30 days notice to the parties to whom this certificate is issued. Dated at: MN License # Authorized Insurance Representative On: 188905v1 24 IM