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<br />L.LlenC : lj~:lJ.J.
<br />
<br />.LL\..l.v.l.r::L.l.V
<br />
<br />PRODUCER
<br />Acordia of Minnesota,
<br />1020 36th Street S.W.
<br />Fargo, ND 58103
<br />701 280-8860
<br />
<br />Inc(CL)
<br />
<br />DATE (MMlDOIVV)
<br />04/20/06
<br />
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTENO OR
<br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />
<br />.AalBIJ,.. CERTIFICATE OF LIABILITY INSURANCE
<br />
<br />INSURED
<br />Tri-State Striping, Inc
<br />305 11th Street West
<br />West Fargo, NO 58078
<br />
<br />INSURERS AFFORDING COVERAGE
<br />
<br />INSURER A General Casualty Company of Wiseo
<br />! INSURER B:
<br />i~~Uf.lER .~:
<br />: INSURER D:
<br />, INSURER E:
<br />
<br />COVERAGES
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREO NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
<br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
<br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AU THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
<br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAlO CLAIMS.
<br />INfl:: TYPE OF INSURANCE POUCY NUMBER - :~k'.feY~F~~VE :Pg~f~ -~Xr.:bRAl1~N
<br />A' GENERALUABIUTY .CCX0399565 ,01/01/06 01/01/07
<br />! X COMMERClAlGENERALLlABlLlTY i ,.
<br />i CLAIMS MADE X OCCUR'
<br />: X ipD Ded: 500
<br />i '
<br />,
<br />; GEN'L AGGREGATE LIMIT APPLIES PER:
<br />, POUCY PRO- LOC
<br />
<br />LIMITS
<br />
<br />: EACH OCCURRENCE ; ~ J,. I 0 0 a. /, ,0 0.0
<br />: ~1_RE.O~A~~.(AflVOll~lj~1 ..$),.0.0 10..00
<br />J~~E.~,_~~~.l~,Y on~ PEl~o~!. . $5 I 000
<br />,PERSONAL&ADVINJUR' ,$1,000,099,
<br />,O~"ERALAGGREGATE..." ,,$2,000,000
<br />PRODUCTS :eOM~IOPAGG :$2, 000,000
<br />
<br />A AUTOMOSD-E UA81UTY
<br />X . ANY AUTO
<br />All OWNED AUTOS
<br />SCHEDULED AUTOS
<br />, X ' HIRED AUTOS
<br />! X NON-QWNED AUTOS
<br />
<br />CBA0399565
<br />
<br />'01/01/06'01/01/07
<br />
<br />COMBINED SINGLE LIMIT
<br />(Eaaccidenl)
<br />
<br />[$1,000,000
<br />
<br />BQDIL. Y INJURY
<br />(Per pelSon)
<br />
<br />$
<br />
<br />BODIL. Y INJURY
<br />(Per accident)
<br />
<br />$
<br />
<br />PROPERTY DAMAGE
<br />, (Per accident)
<br />
<br />$
<br />
<br />: GARAGE LIABILITY
<br />. ANY AUTO
<br />
<br />AUTQONLY. EAACCIDENT ,.$
<br />
<br />OTHER THAN
<br />. AUTO ONLY:
<br />
<br />EA ACe
<br />AGO
<br />
<br />$
<br />$
<br />$2,000,000
<br />,$2,000,000
<br />:$
<br />$
<br />$
<br />
<br />A ! EX<?ESS LIABILITY
<br />X.: OCCUR
<br />
<br />CCU0399565
<br />
<br />,01/01/06 :01/01/07
<br />
<br />EACH OCCURRENCE
<br />. ..__. n._ ___
<br />
<br />ClAlMS MADE :
<br />
<br />. AGGREGATE
<br />
<br />i DEDUCTIBLE
<br />,
<br />X: RETENTION
<br />
<br />$0
<br />
<br />A WORKERS COMPENSATION AND
<br />EMPLOYERS' UABIUTI
<br />
<br />CWC0399565
<br />
<br />01/01/06 01/01/07
<br />
<br />X : WC STATU. OTH. '
<br />__ .:T08'1': liMITS :.I;R
<br />E,L, E.AD" AeeID~NT : $1 0 0 , 0 0 0
<br />EL,.o'S~SE -EAEMPLOYEE! $10 0,000
<br />, E,L. OISEASE . POUey liMIT: $ 5 0 0 0 0 0
<br />
<br />! OTHER
<br />
<br />i i
<br />DESCRIPTION OF OPERAT10NSfLOCATIONSlVEHICLESlEXCLUSIONS ADDEO BY ENDORSEMENT/SPECIAL PROVISIONS
<br />Project: County Project No. CH0606 Pavement Marking Installation
<br />
<br />CERTIFICATE HOLDER
<br />
<br />AD OmONALINSURED' INSURER LElTER:
<br />
<br />CANCELLATION
<br />
<br />Cass County
<br />1201 Main Avenue West
<br />West Fargo, NO 58078
<br />
<br />SHOULD AHYOFTHEABOVE DESCRIBED POlICIES BE CANCELLED BEFORE THE EXPIRATION
<br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAJL30 DAVSWRlTTEN
<br />NOTICETOTHE CERTIFICATE HOLDEANAMEO TOTHELEFT, BUT FA/LURE TODOSOSHALL.
<br />1M POSE NO OBLIGATION OR LIABILI OF ANY KIND UPON THE INSURER,ITS AGENTS OR
<br />"
<br />REPReSENTATIVES. ..~
<br />AUTHORIZED REPRESENTATlV.~.:- ~~
<br />" '
<br />
<br />
<br />.-
<br />
<br />ACORO 25-8 (7/97) 1 of 2
<br />
<br />#S220395/M215657
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