The URL can be used to link to this page

Home My WebLink AboutAcord-7/12/2010AecoRe CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 DATE 7/p)7/2 PRODUCER Willie of Minnesota, Inc. 26 Century Blvd. P. 0. Box 305191 Nashville, TN 37230-5191 877-945-7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED Story Construction Co. 300 S Bell Ave P.O. Box 1668 Amea, IA 50010 1 GENERAL X INSURER A: Arch Insurance Company 11150-001 INSURER B: Great American Insurance Company 16691-000 INSURER C: $ 1, 000,000 $ 100 , 000 INSURER D: INSURER E: MED EXP (Any one person) COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.ppAGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR INSRO TYPE OF INSURANCE POLICY NUMBER POLICY ATE (MMIDDIYnYYY) VE DATE (M�D/YYYYY11 LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 51PKG2300406 7/1/2010 7/1/2011 EACH OCCURRENCE $ 1, 000,000 $ 100 , 000 PREMISES (Earence) CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5 000 PERSONAL&ADV INJURY , $ 1,000,000 $ 2,000,000 GEN'L —1 GENERAL AGGREGATE AGGREGATE LIMIT APPLIES PER: POLICY n JECT fl LOC PRODUCTS - COMP/OP AGG $ 2,000,000 A AUTOMOBILELJABILITY X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 51PKG2300406 7/1/2010 7/1/2011 COMBINED SINGLE LIMIT (Ea accident) $ 1 00p000 i BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ B EXCESS A I X / UMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ 10.000 TUE668028503 7/1/2010 7/1/2011 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1, 000,000 $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LJABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE N OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under SPECIAL PROVISIONS below 51WCI2300306 7/1/2010 7/1/2011 X TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 500, 000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re: F.Y. 2010 E. 6th Street Storm Pump Station Improvements - City of Waterloo Contract# 716 It is agreed that the City of Waterloo IA and Wayne Claassen Engineering and Surveying, Inc. are included as an Additional Insured as respects to General Liability, Auto Liability and Umbrella Liability policies but solely in regards to work being performed by or on behalf of the named insured in connection with the project described herein where required by written contract, construction agreement. CERTIFICATE HOLDER CANCELLATION NONPAYMENT/STATUTORY City of Waterloo City Hall 715 Mulberry Street Waterloo, IA 50703 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTA S. AUT QR ED:E; SENTATIVE ACORD 25 (2009/01) Coll : 3063137 Tp1:1101836 Cert: 14431212 ©1988- 009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Page 2 of 2 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009/01) Co11:3063137 Tp1:1101836 Cert:14431212