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1864 Washington St PE~~IT TO MOVE BUILDING OR DEMOLISH STRUCTURE NOVEMBER 8, 1993 Date: Owner: STATE OF NEBRASKA Contractor: ANDERSON EXCAVATING Name: Dept. of Roads Name: Address: Address: 1824 S. 20TH ST, OMAHA, NE 68105 The above described person is hereby granted a permit to (Move) or a building feet long, and' 96 12 feet high, now located on 1864 Washinqton , City of Blair, Nebraska, to be finally located on to be done on The (Move) or will schedule after r~ceiQt of permit and shall take 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 'crossed): The removal thereof shall be under the direction of the Street Commissioner and the Director of Public Works. . The buiiding is to be used for Bebris purposes. . -~"'_.. ..1-._.. _11 m. L J ,!Jill L --- ~.. . ] L"~lr "fl k __~~U_ ._. J__~lLI .. _ Ll__ ...:1. _... ",1lI~'Wtl"'''''' '.~ __ '" }lr-l., r i-m..I- , .1 . I . , 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 ~/5'7? and is attached. UL~'tc~ 9~~.t'(A,{~iALv~ C. ~!r! ~ty/., er . //' If ) J 1", .===- CERTIFICATE OF INSURANCE ~----------------------------------------------------------------------------------------------------------------------------------- DATE: 11/10/93 PRODUCER JP INSURANCE ASSOCIATES 2328 BOB BOOZER DRIVE OMAHA, NE 68130 (402) 330-3078 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW ------------------------------------------------------------------------- COMPANIES AFFORDING COVERAGE ------------------------------------------------------------------------- COMPANY A LETTER RELIANCE INSURANCE COMPANY -------------------------------------------------------- COMPANY B INSURED LETTER ------------------------------------------------------------------------- RELIANCE NATIONAL INSURANCE COMPANY ------------------------------------------------------------------------- ANDERSON EXCAVATING AND ~RECKING COMPANY, ETAL_ 1824 SOUTH 20TH STREET OMAHA, NEBRASKA 68108 COMPANY C LETTER LIBERTY MUTUAL INSURANCE COMPANY ------------------------------------------------------------------------- COMPANY D LETTER ------------------------------------------------------------------------- COMPANY E LETTER ===== COVERAGES ================================================================================================================== THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT~ITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO ~HICH 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. ---------------------------------------------------------------------------------------------------------------------------------- co LTR TYPE OF INSURANCE POLICY NUMBER POLICY POLICY EFFECTIVE EXPIRATION DATE DATE ALL LIMITS IN THOUSANDS ------------------------------------- --------------------- ---------- ---------- -------------------------------------------- GENERAL LIABILITY A [X] COMMERCIAL GENERAL LIABILITY SJ1652577 [X] [] CLA I MS MADE [X] OCCURRENCE [X] OWNER'S & CONTRACTORS PROTECTIVE [X] ECU HAZARDS [X] BROAD FORM COMP ------------------------------------- --------------------- ---------- ---------- -------------------------------------------- GENERAL AGGREGATE $2000 03/15/93 03/15/94 PRODUCTS-COMP/OPS AGGREGATE $INC PERSONAL & ADVERTISING INJURY $INC EACH OCCURRENCE $1000 FIRE DAMAGE (ANY ONE FIRE) $ 50 MEDICAL EXPENSE(ANY ONE PERSON)$ 5 AUTOMOBILE LIABILITY [ ] ANY AUTO [ ] ALL OWNED AUTOS [ ] SCHEDULED AUTOS [ ] H I RED AUTOS [ ] NON-OWNED AUTOS [ ] GARAGE LIABILITY [ ] CSL $ ---------------- -------------- BODILY INJURY (PER PERSON) $ BODILY INJURY (PER ACCIDENT) $ ---------------- -------------- ------------------------------------- --------------------- ---------- ---------- PROPERTY DAMAGE $ EXCESS LIABILITY SX1653687 03/15/93 03/15/94 [X] UMBRELLA FORM [ ] OTHER THAN UMBRELLA -------------------------------------------- ------------------------------------- --------------------- ---------- ---------- I EACH OCCURRENCE I AGGREGATE ----------------- ----------------- $4000 $4000 -------------------------------------------- C WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY WC1341 044261 013 06/26/93 STATUTORY 06/26/94 -------------------------------------------- ------------------------------------- --------------------- ---------- ---------- -------------------------------------------- I $500 $500 $500 (EACH ACCIDENT) (DISEASE-POLICY LIMIT) (DISEASE-EACH EMPLOYEE) OTHER ---------------------------------------------------------------------------------------------------------------------------------- DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS 1864 WASHINGTON - BLAIR, NEBRASKA ===== CERTIFICATE HOLDER ======================================== CANCELLATION =================================================== SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX- PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVER TO MAIL 30 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. I ......................................................................... ...........................................................:~:::R;:E:o::::E~;;~~!...~~~~..~................... AND NAMED AS ADDITIONAL INSURED: STATE OF NEBRASKA//DEPARTMENT OF ROADS AND THE CITY OF BLAIR II C E R T I F ,, CAT E O F I N S U R A N C E I DATE: 11/10/93 ------------------------------------------------------------------------------------------------------------------------------------ PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, QUINN INSURANCE INC. EXTEND OR ---------- ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW --------------------------------------------------------------- 12335 GOLD STREET COMPANIES AFFORDING COVERAGE OMAHA, NE 68144 ---------------------------------------------------------------- (402) 330-1233 COMPANY A MINNESOTA MUTUAL FIRE AND CASUALTY COMPANY LETTER -------------------------------------------------------- ------------------------------------------------------------------------- COMPANY B INSURED LETTER ------------------------------------------------------------------------- COMPANY C ANDERSON EXCAVATING AND WRECKING COMPANY LETTER 1824 SOUTH 2OTH STREET ------------------------------------------------------------------------- OMAHA, NEBRASKA 68108 COMPANY D LETTER ------------------------------------------------------------------------- COMPANY E LETTER COVERAGES THIS IS TO CERTIFY THAT 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. ---------------------------------------------------------------------------------------------------------------------------------- POLICY POLICY co I IEFFDATEVE EXPDATEION LTR) TYPE OF INSURANCE POLICY NUMBER ALL LIMITS IN THOUSANDS A A GENERAL LIABILITY [ ) COMMERCIAL GENERAL LIABILITY [ ) [ ) CLAIMS MADE [ ) OCCURRENCE [ ) OWNER'S & CONTRACTORS PROTECTIVE ------------------------------------- AUTOMOBILE LIABILITY [ ) ANY AUTO [XI ALL OWNED AUTOS [X) SCHEDULED AUTOS [XI HIRED AUTOS [XI NON -OWNED AUTOS [ ) GARAGE LIABILITY ------------------------------------- EXCESS LIABILITY [ ) UMBRELLA FORM [ ) OTHER THAN UMBRELLA ------------------------------------- WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY ------------------------------------- OTHER EQUIPMENT 931462 --------------------- 931462 GENERAL AGGREGATE $ PRODUCTS-COMP/OPS AGGREGATE $ PERSONAL & ADVERTISING INJURY $ EACH OCCURRENCE $ FIRE DAMAGE (ANY ONE FIRE) $ MEDICAL EXPENSE(ANY ONE PERSON)$ -------------------------------------------- CSL $1000 BODILY INJURY (PER PERSON) $ BODILY INJURY (PER ACCIDENT) $ PROPERTY DAMAGE $ -------------------------------------------- EACH OCCURRENCE AGGREGATE $ $ -------------- -------- ----------------------------------- STATUTORY -------------------------------------------- $ (EACH ACCIDENT) $ (DISEASE -POLICY LIMIT) $ (DISEASE -EACH EMPLOYEE) ----- -------------------------------------- PER SCHEDULE -------------------------------------------------------------------------------------------------------------------- DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS 1864 WASHINGTON, BLAIR, NEBRASKA CERTIFICATE HOLDER ________________________________________ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX- PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVER TO MAIL STATE OF NEBRASKA//DEPARTMENT OF ROADS 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE AND LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR THE CITY OF BLAIR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. BLAIR, NEBRASKA ------------------------------------------------------------------------- AUTHORIZED REPRESENTATIV CHARLES V. DARR ti /� �( / /