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ACORDN CERTIFICATE OF LIABILITY INSURANCE CSR BH I DATE (MM/DD/YYYY) LEEJO-l 06/02/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Dawson Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 721 1st Avenue North, Box 1958 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fargo ND 58102 Phone: 701-237-3311 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Cincinnati Insurance Companies 10677 INSURER B: Lee Jones & Son Construction INSURER C: Com~any & LJS Investment, LLP 290 F1echtner Dr. INSURER 0: Fargo ND 58103 INSURER E: 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSRl: TYPE OF INSURANCE POLICY NUMBER DA~E IMMIDDIYY '8k'&"IMMlbONY,N LIMITS GENERAL LIABILITY EACH OCCURRENCE $100,000 f-- A X COMMERCIAL GENERAL LIABILITY CPP0682384 07/01/04 07/01/05 ~F:MISEs (Ea occurence) $ 100,000 I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5,000 X ND Stop Gap PERSONAL & ADV INJURY $ 100,000 - GENERAL AGGREGATE $ 500,000 - GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ 500,000 I Iil PRO- n POLICY X JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - $ 500,000 A ~ ANY AUTO CPP0682384 07/01/04 07/01/05 (Ea accident) ALL OWNED AUTOS BODILY INJURY - $ SCHEDULED AUTOS (Per person) - X HIRED AUTOS BODILY INJURY - $ ~ NON-OWNED AUTOS (Per accident) f-- PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ R ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 3,000,000 A ~ OCCUR D CLAIMS MADE CCC4421075 07/01/04 07/01/05 AGGREGATE $ 3,000,000 $ ==j DEDUCTIBLE $ RETENTION $ $ I WI:. :;TA1U- I IUJ~- WORKERS COMPENSATION AND X TORY LIMITS A EMPLOYERS' LIABILITY WC19093501 (MN) 07/01/43 07/01/05 EL. EACH ACCIDENT $ 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under EL DISEASE - POLICY LIMIT $ 500,000 SPECIAL PROVISIONS below OTHER A Installation Float CPP0682384 07/01/04 07/01/05 Any 1 Loc $750,000 Aaareaate $750,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Cass County Vector Control, Vector Control Office, West Fargo, ND CASSC-4 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ 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 REPRESENTATIVES. AUT ESENTATlVE CERTIFICATE HOLDER Cass County Government P. O. Box 2806 Fargo ND 58108 ACORD 25 (2001/08)