The URL can be used to link to this page

JTech COL/ AC40R o® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 04/27/2022 THIS CERTIFICATE IS ISSUED ASA 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(les) must have ADDITIONAL INSURED provisions or 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). PRODUCER CONTACT Katie Shipp NAME: Dodge Partners Insurance, LLC a/c No Ext : (402) 938-5016 FAX c, No : (402) 938-5090 E-MAIL Katie.Shipp@dodgepartners.com ADDRESS: 8701 W Dodge Rd, Suite 100 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Employers Mutual Casualty Company 21415 Omaha NE 68114-3429 INSURED INSURER B: Accident Fund Insurance Co of America 10166 J TECH CONSTRUCTION, LLC INSURER C : GuideOne National Insurance Co 14167 6200 HAVELOCK AVE INSURER D: INSURER E INSURER F: LINCOLN NE 68507-1235 COVERAGES CERTIFICATE NUMBER: 2022-2023 REVISION NUMBER: 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. INSR LTR TYPE OF INSURANCE ADUL5U1311 INSD WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 __1 OCCUR CLAIMS -MADE PREMISES IlEa occurrence $ 500,000 MED EXP (Any one person) $ 10,000 PERSONAL a ADV INJURY $ 1,000,000 A N 5D85757 05/04/2022 05/04/2023 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 - POLICY ❑X JECT F-1 LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident BODILY INJURY (Per person) $ X ANYAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS 5E85757 05/04/2022 05/04/2023 BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Uninsured motorist $ 1,000,000 XUMBRELLALIAB OCCUR ��,.Z6.„-,..y.-,.„.„ 2,000,000 EACH OCCURRENCE $ AGGREGATE $ 2,000,000 A EXCESSLIIAB HCLAIMS-MADE 5,185757 05/04/2022 05/04/2023 DED RETENTION $ 10,000 X $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? FN] (Mandatory in NH) N / A 100026730 05/04/2022 05/04/2023 �/ X PER EORH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below C rofessional Liability tt ENV562003763-01 11/02/2021 11/02/2022 Pollution Aggregate $2,000,000 Contractor's Professional $1,000,000 Poll Ded / Prof Ded $2,500 / $5,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) IiL191a►1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Blair ACCORDANCE WITH THE POLICY PROVISIONS. 218 So. 16th St. AUTHORIZED REPRESENTATIVE Blair NE 68008-2010 1 i .�- @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 00022544 LOC #: AlC'C. _1?0 ADDITIONAL REMARKS SCHEDULE `-_� Page of AGENCY Dodge Partners Insurance, LLC NAMED INSURED J TECH CONSTRUCTION, LLC POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance: Notes CONTRACTUAL LIABILITY APPLIES PER POLICY FORMS AND CONDITIONS *'All entities required by written contract are included in the below forms / endorsements— General Liability: Additional Insured status for ongoing operations applies only to the extent provided in form CG7578 when required by written contract. Waiver of Subrogation applies only to the extent provided in form CG7578 when required by written contract. Primary and non-contributory applies only to the extent provided in form CG7578 when required by written contract. Per Project Aggregate applies only to the extent provided by form CG7429 when required by written contract. Auto Liability: Additional Insured status applies only to the extent provided in form CA7450 when required by written contract. Waiver of Subrogation applies only to the extent provided in form CA7450 when required by written contract. Umbrella: Umbrella Liability follows form to General Liability, Automobile Liability and Employer's Liability. Additional insured status follow form. Pollution Liability: Additional Insured status for ongoing operations applies only to the extent provided in form G02212-4YA when required by written contract. Waiver of Subrogation applies only to the extent provided in form G002184YA when required by written contract. Primary and non-contributory applies only to the extent provided in form G002164YP when required by written contract. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD