Insurance Cert - Widmer WIDME-2 OP ID:LK
DRTE(MMDDYYYY)
CERTIFICATE F LIABILITY 11
1 0/11/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: Ir the Certlncate nolder Is an ADDITIONAL INSURED, the policy(Ies) must be endorsed. If SUBROGATION IS WAIVED, suo)ect 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 endorserrient(sy',
PRODUCER 1 CONTACT
Maguire Agency NAME: Todd HII enkam ,CIC
W , , � a FXH ;1970 Oakcr-esf Avenuo,#000 a $31-$38-9762
Roseville, MN 55113 i ADDAREss: thilgenkamp@maguireagency.com
Todd Hilgenkamp, CIC
INSURERS AFFORDING COVERAGE NAIC N
INSURERA: United Fire Group 13021
INSURED Widmer Construction LLC INSURER R: I
9455 County Road 15
Minnetrista,MN 55359 INSURER C:
INSURER D:
INSURER E:
INSURERP:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT 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,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSR TYPE OF INSURANCE ADDLSUBR POLICY POLICYEXP
LTR POLICYNUMBER MMjDD MMIDD NM LIMITS
GENERAL LIABILITY
EACHOCCURRENCE $ 1,000,000
A X COMMERCIALGENERALLIABILITY X 60479959 08101/2016 08/01/2017 DAMAGE TO RENTED
PREMISES Ea occurrence $ 100,000
CLAIMS MADE [FV— OCCUR MEDEY.P(An —p--) ¢ ,,nno
PERSONAL&ADVINJURY $ 1,000,000
GENERALAGGREGATE $ 2,000,000
GEN'LAGGREGATE LIMITAPPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,000
POLICV X PRO- Loc $
AUTOMOBILE LIABILITY E02Bc�eDSINGLELIMIT $ 1,000,000
A X ANY AUTO 60479959 0810112016 08101/2017 BODILY INJURY(Per person) $ '...
ALLOWNED SCHEDULED BODILY INJURY(Per $
AUTOS AUTOS ( )
IIIriCDAVTOC NON-OWNED PROPERTY DAMAGE $
AUTOS f'Cf:AOCIDCN
$
X UMBRELLALIAB X OCCUR EACHOCCURRENCE $ 5,000,000
A EXCESSLIAB CLAIMS-MADE 60479959 08!0112016 08!0112017 AGGREGATE $ 5,000,000
DrD PE
WORKERS COMPENSATION X W C STATU- OTH-
AND EMPLOYERS'LIABILITY IM ITS PR
IT
A ANY PROPRIETORIPARTNEMEXECUTIVE Y 1 N 60479959 08/0112016 0810112017 E.L.EACHACCIDENT $ 500,000
OFFICERIMEMBER EXCLUDED? � N I R
(Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,000
Ryes,describe under ATI E.L.DIe . POLIOV LIMIT inn nnn
A Rented Equipment 60479959 08/0112016 08/01/2017 Limit 600,000
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
2016 Trunk Watermain Extension Project City of Shorewood, MN Project# 16-04
City of Shorewood and WSB and Associates Inc. are included as additional
insured under general liability as provided by endorsements CG72010215 &
IL71051014.
CERTIFICATE HOLDER CANCELLATION
XSHOREW
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Ci ofShorewaod THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ry ACCORDANCE WITH THE POLICY PROVISIONS.
5755 Country Club Road
Shorewood„MN 55331 AUTHORIZED REPRESENTATIVE
d 1988-2010 ACORD CORPORATION. All rights rese rued.
ACORD26(2010105) The ACORD name and logo are registered marks ofACORD
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