826 S 19th St
!
/
PER~IT TO MOVE BUILDING OR DEMOLISH STRUCTURE
Fee Paid: $15.00
Date:
Owner:
Contractor:
Name:
\
Name:
Address:
i' i' j'
Address:
The above described person is hereby granted a permit to (Move) 01:'
(Demolish) a building
;) ['
feet long, and
feet high,
now located on II \ '
(' " . Ii ,i
City of Blair, Nebraska, to be
finally located on
;/
The (Move) O'r
and shall take
(Demolit~on) is to be done on
hours. The route to be taken in the removal thereof is as
follows: (Here designate the names and numbers of the streets, alleys,
or public grounds to be 'crassed): ( f i Ii ',i '
,; 1 I C. t.l
i Ce
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.I(,r,
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The removal thereof shall be under the direction of the Street Commissioner
and the Director of Public Works. . The building is to be used for
purposes.
A stat~ment that all taxes and special assessments on the building to be
moved or demolished and on the land from which it is to be moved or demolished
have been fully paid was received
l',r"
i
and is attached.
A corporate surety bond or two personal sureties to pay all damages that
may be sustained to any property, public or private and including curbs,
paving, manholes, public utility lines and pipes, by reason of the moving
or demolishing such building was received on
and is attached.
-' I i r "
Cit~ Clerk
City Administrator
K.A Y J. t:KWIN
WASHINGTON COUNTY TREASURER
P.O. Box 348 · Blair, Nebraska 68008
(402) 426-6888
DATE~O?rt1?~~ 3~/ /frr
TO WHOM IT MAY CONCERN:
ON THIS DAY . \ ~ (B~
PAID THE TAXES ON .,3 - / j- / r~ ! (
FOR THE YEARS OF . /9' 9?
PLEASE CONTACT OUR OFFICE IF
THERE ARE ANY QUESTIONS REGARDING PAYMENT MADE.
THANK YOU,
J:~
.~
12 .3 / /- /7- / I
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PE~~IT TO MOVE BUILDING OR DEMOLISH STRUCTURE
Fee Paid: $15.00
Date:
Owner:
Contractor:
Name:
Name:
Address:
Address:
The above described person is hereby granted a permit to (Move) Qu
(Demolish) a building
i" .,
') (:-)
feet long, and
feet high,
now located on WI
, City of Blair, Nebraska, to be
finally located onl\
\- , ti r~
Ji
t 1. {'t, \ ~'
The (Move) 0.17
(Demolition) is to be done on
I .
\
and shall take
,,"
(,
hours. The route to be taken in the removal thereof is as
follows: (Here designate the names and numbers of the streets, alleys,
or public grounds to be 'cressed):
\;"
, I_.
; f ,~ ; ( J r-f~,-;, ! ;
(,
LJ ,
: \
\ .\
i' ~; i
The removal thereof shall be under the direction of the Street Commissioner
and the Director of Public Works. . The building is to be used for
\,: ( ~'- ~ t
purposes.
A statement that all taxes and special assessments on the building to be
moved or demolished and on the land from which it is to be moved or demolished
have been fully paid was received
I .
\ .'
and is attached.
A corporate surety bond or two personal sureties to pay all damages that
may be sustained to any property, public or private and including curbs,
paving, manholes, public utility lines and pipes, by reason of the moving
Qrd.emolishing such building was received on
and is attached.
I
I
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City Clerk
City Administrator
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ACORDTM
..............,..'.,................."....................,....,..........................,...............,..........,.......................................................,............................,........,
,..... ."...,...... ."" ... .....""' ...... '....... "..... ........ ..., ......... ... ........... ............. ......... .. .......
.....Q.~.~pr.I..~I.~4"1).~.......~.~.......~I~.B.I..~ti~.......,.~.~.~..g~..~.~.~...9Jd~R~4.~........... . DA;~;;;;;~
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.
COMPANIES AFFORDING COVERAGE
PRODUCER
The Maguire Agency
1935 West County Road B-2,#241
Rosevi1le MN 55113
Matthew A. Sundeen
Phone No. 651-638-9100 Fax No. 651-638-9762
INSURED
COMPANY
A
Federal Insurance Company
COMPANY
B
Morrow's, Inc.
P.O. Box 64
Jackson, NE 68743
COMPANY
C
COMPANY
D
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.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DDIYYI DATE (MM/DDIYYI
LIMITS
A
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE [!] OCCUR
OWNER'S & CONTRACTOR'S PROT
79395896
06/01/98
06/01/99
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
PERSONAL & ADV INJURY
EACH OCCURRENCE
FIRE DAMAGE (Anyone fire)
MED EXP (Anyone person)
$500,000
$500,000
$ 500,000
$500,000
$50,000
$ 5,000
$1,000,000
A
AUTOMOBILE LIABILITY
X ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
X HIRED AUTOS
X NON.OWNED AUTOS
79395897
06/01/98
06/01/99
COMBINED SINGLE LIMIT
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EACH ACCIDENT
AGGREGATE
EACH OCCURRENCE
AGGREGATE
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
EL EACH ACCIDENT
THE PROPRIETORI
PARTNERS/EXECUTIVE
OFFICERS ARE:
OTHER
INCL
EXCL
EL DISEASE. POLICY LIMIT
EL DISEASE - EA EMPLOYEE
A Cargo Coverage
79395896
06/01/98
06/01/99
ACV Up To
$75,000.
$500. Ded.
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
XBLAIRZ
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
City of Blair
Attn: Brenda Taylor
218 South 16th Street
Blair, NE 68008
Matthew A. Sundeen
PRODUCER
.......-. . .... ...... .....,...............,........... ................................'....,...........................'.................................,..............................................,................. ". ...., .....................
...O....."..'.'...."..'.'.'."P...'.....'."..'..' I..'..",..".... .'..'.'.....'.....m'...".'p....'.'. .'....11..' .,.,.,.., ."".".,. "1'(1:"""""""""""""""""1"""" .,.... ......'.7it. . '.N.....O.....'.'.'....".'.".'."...'...'......... ...
A COR'D '" "'E"'R'" ......I'.p:.'I'. "A: ';'f..e.,<". .'." ....' "'J'1J{'" <"B'I'['" .. "'1"""'1' "N" ""'W"" "R"'" '.".' ,. ,JE'.Q...<..p""J.D"'.'cr'...s.'..... "
',:: "-:... ," .:.-:, .' .-:-::-::-:. .:... .:-: :-:..,' -:-:-:: ...., ..... : .:: .::. .-:-: -:'.':- ..;-:....... - >. <,'-: -;-:", . ".,.- .... :. :...... ",". :- .:-:'-,. ';',':-: ....,;-
.. ™i\," "Hii . ','.\'.~()R~O,+$? ".... 1 0 / 0 2 / 9 8
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.
COMPANIES AFFORDING COVERAGE
DATE (MM/DDNYI
The Maguire Agency
1935 West County Road B-2,#241
Roseville MN 55113
Matthew A. Sundeen
Phone No. 651-638-9100 Fax No. 651-638-9762
INSURED
COMPANY
A
Federal Insurance Company
COMPANY
B
Morrow's, Inc.
P.O. Box 64
Jackson, NE 68743
COMPANY
C
COMPANY
D
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.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DDNY) DATE (MM/DDNY)
LIMITS
GENERAL LIABILITY
A X COMMERCIAL GENERAL LIABILITY 79395896
CLAIMS MADE [iJ OCCUR
OWNER'S & CONTRACTOR'S PROT
06/01/98
GENERAL AGGREGATE $ 500 , 000
06/01/99 PRODUCTS.COMP/OPAGG $ 500,000
PERSONAL & ADV INJURY $ 500, 000
EACH OCCURRENCE $ 500 , 000
FIRE DAMAGE (Anyone fire) $ 50, 0 0 0
MED EXP (Anyone personl $ 5, 000
A
AUTOMOBILE LIABILITY
X ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
X HIRED AUTOS
X NON.OWNED AUTOS
79395897
06/01/98
06/01/99
COMBINED SINGLE LIMIT
$1,000,000
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
GARAGE LIABILITY
ANY AUTO
AUTO ONLY. EA ACCIDENT
OTHER THAN AUTO ONLY:
EACH ACCIDENT
AGGREGATE
EACH OCCURRENCE
AGGREGATE
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
THE PROPRIETOR/
PARTNERS/EXECUTIVE
OFFICERS ARE:
OTHER
INCL
EXCL
EL DISEASE - POLICY LIMIT
EL DISEASE. EA EMPLOYEE
A Cargo Coverage
79395896
06/01/98
06/01/99
ACV Up To
$75,000.
$500. Ded.
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
XBLAIRZ
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Blair
Attn: Brenda Taylor
218 South 16th Street
Blair, NE 68008
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO
BUT FAILURE TO MAIL ~CH NOTICE SHALL IMPOSE
OF ANY KIND UPON T A OMPA , ITS
AUTHORIZED REPRESENT 11
\ ,
Matthew A. Suhd
.. .' .... .........>1SJ@9QRPCOR(?()FlATlO . )@~tJ~
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