Alspach COL.tifFrom:Joy Nickolite FaxID:OMAHA IN; URANCE Page 2 of 4 Oate:8/1/2016 09:53 AM Page:2 of 4
ALSPA-1 (OP ID: JN
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CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYY(Y)
0810112016
THIS CERTIFICA'T'E IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED By THE POLICIES
(11 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement s). _
PRODUt:ER ��
Omaha Insurance Services Inc.
11132 0 StreetArc.
Omaha, NE 68137
Tim Miers
NAMTim Miers
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PHONE — --- - — FAX --- ---
No, Ex�402_592-4455 A( rc, NNS: 402-5$2µ4455
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ADDRESS_ trnier�.orraha01 IrlSut'CmaaiGe't
INSU_R_ER($) AFFORDING COVERAGE I_NAIC #
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INSURER A: Al1tO-o1hJn@rS — ------ A------
18988-----
39445281
INSURED
Nuchae! Alspach
16015 Josephine St
Omaha, NE 68136
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INSURERS
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INSURER C:
IED ECF (Any orF 'nelson; -
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INSURER D_--------
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INSURER C------------
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INSURER F :
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(4n%1rpAr:PS r`PPTIPIrATC NIIMR;:P• PF:VISION NIJMrAPR,
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 NAVE BEEN REDUCED BY PAID CLAIMS.
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LTR TYPE OF INSURANCE �y
A X CbMMERCIAL GENFRAL LIABILITY
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POLICY NUMBER
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3 1,000,000
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CLAIMS -!JADE X OCCUR
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04101!2016
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04!0117.017
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100 000
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WORI(ERS COMPENSATION
STAT!JTE ER
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR�PFRTNERiEXECUTI�/E YD
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(Mandatory in NH)
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is requlrod)
r`C0$14It"ATC 6lnl n= ! f ANN PI I ATION'
f � CITY046
SHOU
EOFLD ANY OF THE ABOVE DESCRIBEn POLICIES BE CANCELLED BEFORE
DATE , NOo ICE WILL BE DELIVERED IN
THE EXPIRATIONTHERE�
Litt' Of flair
ACCORDANCE WITH THE POLICY PROVISIONS, - -
218 S 96th Street
AUTHORIZED REPRESENTATIVE
Blair, NE 68008
O 1988-2014 ACORD CORPORATION. illi rights reserved.
ACORD 25 (2014!01) The ACORD name and logo are registered marks of ACORD