794 N 21st St
-1 ") I ,ff II,';
(}i
PE~~IT TO MOVE BUILDING OR DID10LISH STRUCTURE
Fee Paid: $15.00
Date:
1/- -1- t{PY-
Owner:
, ~J ,\- ' (\1 n,(i
Name:\..~l~l~'), U lX)\Vj~---
Address: 1; 0 5 if/; ~Jv~w1/tYt C;V,
Name:
Contractor:
~~Kif) LCe,)LicL/'Q"~
~j (t-l~{4;'-
Address: -iff () cr~
-~""\
The above described person is hereby granted a permit t~~1 or
(Demolish) abuilding 'B 3
,qVN 0) Sf ~'_I
now located on . G . ~S '
Lu+ 9 A(\dcJ:sOY~ AddckoYJ
feet long, and'
/~
feet high,
, City of Blair, Nebraska, to be
finally located on
The (Move) or
(Demolition) is to be done on
and shall take
Lf 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 'crossed): 5.cL... cct/.{\C j\.Lci.~.
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
Re~Sl'C~ rd..l().J f\(/UK_~
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
J! ~ /IP'(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,'manho1es, public utility lines and pipes, by reason of the moving
or demolishing such building was received on
.I:!
l;l /.-
/UI'7
.
and is attached.
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PRODUCER
:.:: .,. .~ ~"',' ..:..:.;.. :"':":"':"~:':-:';':::'::y'...::....,..,..
ISSUE DATE (MMiODf1'YJ
05/04/95
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATf
DOES NOT AMEND, EXTEND on ALTER THE COVERAGE AFFORDED BY THf
POLICIES BELOW.
The Mnguire Agency
1935 West Co Road B-2, #241
P. O. Box 64316
St. Paul, MN 55164-0316
COMPANIES AFFORDING COVERAGE
COMPANY A
l.ET1ER
St. Paul Companies
SAO
COMPANY 8
l.ET1ER
INSURED
O'Neil Company, Inc.
P. O. Box 1113
Williston, ND 58801
COMPANY C
l.ET1ER
COMPANY D
l.ET1ER
COMPANY E
l.ET1ER
THIS IS TO CERTIFY THAT THE POl-ICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERICD
INDICATED. NOTWITHSTANDING ANY AEQUIREMENT, TERM OR CONDfTlON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO I'v'HICH T"';IS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEPJ.~S
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE POUCY NUMBER POUCY EFFECTIVE POUCY EXPIRATION I
DATE (MMIODiYY) DATE (MMIOOIYY)
GENERAL AGGREGATE
PRODUCTS-COMPIOP AGG.
PERSONAL & ADV. INJURY
EACH OCCURRENCE
FIRE DAMAGE (Any one tire) S
MED. EXPENSE (Any on. person S
CO
LTRI
I
GENERAL UABlUTY
X COMMERCIAl. GENERAL LIABILITY
CLAIMS MADE W OCCUR.
OWNER'S & CONTRACTOR'S PROT
06/01195
06/01196
CK06307830
A
AUTOI.IOBlLE UABlUTY
X >>N AUTO
ALL OWNED AUTOS
A SCHEDULED AUTOS
HIRED AUTOS
NON-oWNEO AUTOS
GARAGE UAllIUlY
06/01195
06/01196
CK06307830
EXCESS lJABlUTY ,
A X
06101195
06/01196
CK063Q7830 ,.,'
OTHER tHAN UMBREllA FORM
WORKER'S COIoFENSAnON
ANO
EMPLOYERS' UJ,81UTY
06/01196
A
OlliER
Cargo Coverage
, 06101195
OESCRIPTION OF OPERATlONSJLOCATIONSIVEHICl.ESlaP€ClAL rrDoIS '
',:X:'(~jt:~}~:~"..?tj.;~~ :
UMlTS
Is
1,000.000
1,000,000
1.000.000
1,000,000
50,000
5,000
COMBINED SINGLE S 1,000,000
LIMIT
BODILY INJURY S
(p., person)
BODILY INJURY S
IP" acddem)
PROPERlY DAMAGE S
EACH OCCURRENCE S 3,000,000
AGOREGA TE S 3,000,000
~"~f<<f.t'mt<<"flfi~f.4 ir&ttft~~@~r!~tf:~;f:@r:~~r~~
STA TUTORY L~ITS ~i.~?~g1jrt.~tt~(1;1~~t~M~~M;~;;;~t
EACH ACciDENT S
OISEASE-POLlCY LiMIT S
DISEASE-lOACH EMPlOYEE S
Specllll Form - $500 Ded.
$75,000 Any One Item
, .' :N.~ ::..~ mON;.
, '. SHOULD JJN OF lHE ABOVE DESCRIBED POLICIES BE CANCELLED BE:FORE THE
" W. ,EXPIRATION DATE lHEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL lL DAYS WRITTEN NOTICE TO TI-lE CERTIFICATE HOLDER NAMED TO THE
'LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
, LIABILITY OF ANY KIND UPON THE COMPANY, rrs AGENTS OR REPRESENTATIVES,
, ;~ AUTHORIZEO REPRESENTATlVE
"'cVdL/d-~ r/. ~
..... .... }t:$4t:@~Wt.~'A~,~,tttc.oln?o.R4'n6tJ6g00
State of Montana
Gross Vehicle Weight Division
Departm~nt of HIghways
Box 4639
Helena, MT 59604