Takoda COLTAKOGRE-01 BCARSLON
,d►`coRv
CERTIFICATE OF LIABILITY INSURANCE
DATE(Ml2020YY)
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 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
NAME:
Jones Group
1511 Silver Street
Ashland, NE 68003
PHONE 4 FAX
(AIC, No, Ext): ( 02) 9443355 (ANC, No):
AMDRIESS:
INSURERS AFFORDING COVERAGE NAIC #
8/1/2020
INSURER A: Columbia Insurance Company
DAMAGE TO RENTED 100,000
PREMISES Ea occurrence)$
INSURED
INSURER B: Travelers Insurance Company
INSURER C:
Takoda Green Inc
INSURER D:
2905 N. 69th St.
Omaha, NE 68104
INSURER E
INSURER F:
AUTOMOBILE
X
COVERAGES CERTIFICATE NUMBER: 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
ADDL
SD
SUER
D
POLICY NUMBER
POLICY EFF
MIDD
POLICY EXP
MM/DD
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ® OCCUR
CMPNE0000017421
8/1/2019
8/1/2020
EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED 100,000
PREMISES Ea occurrence)$
MED EXP (Any oneperson) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY a JECTPRO-[:]LOC
OTHER:
GENERAL AGGREGATE $ 2,000,000
PRODUCTS-COMP/OPAGG $ 2,000,000
$
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
OWNED X SCHEDULED
AUTOS ONLY AUTOS
p
AUTOS ONLY X AUOTOS ONLY
CAPNE0000017421
8/1/2019
8/1/2020
COMBINED SINGLE LIMIT 1,000,000
Ea accintde$
BODILY INJURY Perperson) $
BODILY
BODILY INJURY Per accident $
Pe�acEcRdwA AMAGE $
$
A
X
UMBRELLA LIARX
EXCESS LIAB
OCCUR
CLAIMS -MADE
CUPNE2000003164
8/1/2019
8/1/2020
EACH OCCURRENCE $ 1,000,000
AGGREGATE $
DED I X I RETENTIONS 10,000
$ 1,000,000
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY YIN
OFFICER/MEMBER EXCLUDED? ECUTIVE ❑
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N /A
1K682161
11/1/2019
11/1/2020
STATUTE EER
E.L. EACH ACCIDENT $ 100,000
E.L. DISEASE - EA EMPLOYEE $ 100,000
I E.L. DISEASE - POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Ci Of Blair
City
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
218 South 16th St.
Blair, NE 68008
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD