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May, 9. 2017 12; 45PM No, 9462 P. 1 A "' DATE (MM/ddm YY) CERTIFICATE OF LIABII.,M`I"'Y INSURANCE THIS CERTIFICATE 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 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(ies) 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 Cori ficate holder in lieu of such endorsement(s), PRODUCER Peterson Brothers Insurance, Inc. 13939 Cold C±rcle *200 Omaha. NE 68144-2359 INSURED CHET E CRTNTaAW 62115 READ ST OMAHA NE 6181152-2233 CONTACT NAME: Ann Freems.ri PHONE (402) 330-2048 ext- SDE FAc - (902)334-9861 E.MAIL;ann@PeterS4nbr6thnrsin%11><'enCe-coin INSURERS AFFORDING COVERAGE NAIL H INSURERAAllied Insurance Company 19100 INSURER B INsuRERc: INSURERD: INSURER E INSURE F: COVERAGES CERTIFICATE NUMBER-CL1332003231 REVISION NUMBER: THIS 18 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. TR TYPEOFIN5URANCE ADPL 218 So. 16th St. Blair, WE 68008-2010 POLICYNUMBE MM106NEYYY MMIODY�P LIMIT) —miziffil GENERAL LIASILITY EACH OCCURRENCE s 1,000,000 -DAMAGE TO RENT Q PREMISES Ee o $ 100,000 X COMMERCIAL GENERAL LIABILITY MED EXP (Any oneperson) S 5, 000 A CLAIMS -MADE © OCCUR NCPMCT07203380159 /1/2017 /1/2018 PERSONAL h ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AbbREGATH LIMrr APPLIES PER: PRODUCTS • COMPIOP ACG S 2,000,000 $ POLICYFIJECT F7 PRO- LOC LIABILITY NED S INGLE LIMITAUTOMOBILE Ea ee ANY AUTO BODILY INJURY (Per porsan) $ BODILY INJURY (Per eccldvnt) $ ALL OWNEDSCHEDULED AUTO$ AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE 5 6 UMBRELLA LJAB HCLAIMS-MADE OCCUR EACH OCCURRENCE 3 AGGREGATE `s EXCESS UA13 DED RETENTION 5I WORKERS COMPENSATION WC YTATU- TH- AND "MPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT s E•4, DISEASE, EA EMFLOYEq S OFRCERIMEMBER EXCLUDED? El (MAndaiary in NH) N/A E,I_ DISEASE -POLICY LIMIT $ If as, descrlbe under DESCRIPTION OP OPERATIONS bip1ow DESCRIPTION OF OPERATIONS I LOOATIONS I VEHICLES (AHach ACORD 101, Additional Romnrks Snhedule, if more space Is rcgalmd) d-=0- lelrA-rG tans DEP r-ANCFLLATION (402)426-4195 SHOULD ANY OF THE ABOVE pFSCRIBED POLICIES BE OANCELLED BEFORE THE t:XPIRATION DATE THEKE017, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of 131air 218 So. 16th St. Blair, WE 68008-2010 AUTHORIZFD REPRESENTATIVE Ann Freeman/AME' ACORD 25 (2010109) INS025 (201005).01 x'1888.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD