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PrairieC COLACOR" CERTIFICATE OF LIABILITY INSURANCE lk./ DATE(MM/DD/YYYY) 1 12/20/2022 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 Hub International Great Plains 11516 Miracle Hills Drive Suite 100 CONTACT NAME: Travis Nelson PHONE 800-288-5501 ac No:402-964-5454 E-MAIL ADDRESS: Travis.Nelson@hubinternational.com INSURERS AFFORDING COVERAGE NAIC# Omaha NE 68154 INSURER A: Employers Mutual Casualty Company 21415 INSURED PRAICON-04 INSURER B : Brick6treet Mutual Insurance Company 12372 Prairie Construction Company 13316 B Street INSURER C : INSURERD: Omaha NE 68144-3612 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:879949464 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 INM SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/D IYYYYI LIMITS A X COMMERCIALGENERALLIABILITY CLAIMS -MADE � OCCUR 6D40347 1/1/2023 1/1/2024 EACH OCCURRENCE $1,000,000 DAMAGE TTED PREM SESOE. occurrence) $ 500,000 MED EXP (Any one person) $10,000 PERSONAL& ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT PRO- LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED IAUTOS ONLY AUTOS ONLY 6E40347 1/1/2023 1/1/2024 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PERTY DAMAGE PROPER Per accident $ $ A X UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS -MADE 6J40347 1/1/2023 1/1/2024 EACH OCCURRENCE $10,000,000 AGGREGATE $ 10,000,000 DIED I X I RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY AND Y / ANYPROPRIETOR/PARTNER/EXECUTIVE ❑N OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WCS3013161 1/1/2023 1/l/2024 XER OTH- ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 A Contractors Equipment 6C40347 1/1/2023 1/1/2024 Scheduled Equipment Leased/Rented Equip $265,332 $100,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Blair 218 S 16th St Blair NE 68008 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD