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RemodelN COL.tifFax Server 2/25/2020 9:48:26 PM PAGE 1/002 Fax Server Cltonf.*- inonan Pr-Knnna ACORD. CERTIFICATE OF LIABILITY INSURANCE DYYY) ATE (A9M/DDlY02/25/2020 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(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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER INSPRO Insurance P.O. Box 6847 CONTACT NAME: Tarin Gleselmann PHONE Fax A/C No ,):402.483.4500A1C No : ADDRESS: tgieselmann@insproins.com Lincoln, NE 68506 402 483-4500 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Donegal Insurance Group 13692 INSURED INSURER 13: BrickStreet Mutual Insurance Co Remodel Nebraska, LLC, 12227 So 217th Ave INSURER C: PERSONAL &ADV INJURY $1,000,000 Gretna, NE 68028 INSURER D: INSURER E : INSURER F: A 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 CONTRACTOR 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 INSR UBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR X PD Ded:250 CPA9316597 2/13/2020 02/13/2021 EAACCHgOCCURRENCE $1,000,000 PREMISES Ea. nence $100000 MED EXP (Anyone person) $5,000 PERSONAL &ADV INJURY $1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: POLICY JECOT LOC OTHER: GENERAL AGGREGATE s2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY X NON -OWNED AUTOS ONLY I CAA9316697 2/13/2020 02/13/2021 COMBINED�BISIIJGLE LIMIT 110001000 BODILY INJURY (Per parson) $ BODILYINJURY(Peraccident) $ PROPERTY DAMAGE $ Per accIdeni UMBRELLA LIAROCCUR EXCESSLIAB HCLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROP RIETORIPARTNER/EXECUTIVE Y/N OFFICER/MEMBEREXCLUDED? � (Mandatory in NH) DESCdescribe under RIPTION OF OPERATIONS below N/A WCB1030988 2/13/2020 02/13/2021 X SEA LITE I EER E.L.EACH ACCIDENT $SOD OOO E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE • POLICY LIMIT 1 $500,000 DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES (AGORD 101, Additional Remarks Schedule, may be attached i1 more space Is required) (:AN(:CLLA Cit of Blair SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1210181/M1210176 SME