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Monster COL© DATE (MMIDDIYYYY) CERTIFICATE OI I ' 12/19/2022 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 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 Brandon Frink Janice Peterson Insurance Agency 9785 Q Street, Ste 4 14 00- Omaha, NE 68127 NAME: PHONE )•402-593-1899 (AAic Ne),402-592-6903 ADDRESS: Brandon.Frink.DNXY@StateFarm.coin INSURER(S) AFFORDING COVERAGE NAIC# INSURER A:State Farm Fire and Casualty Company 26143 INSURED MONSTER ELECTRIC INC 5810 S 92ND CI R OMAHA NE 68127-3515 INSURERB: INSURER C : IIJCII... Y 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 SUBR POLICY NUMBER POLICY EFF MMDIYYYY ID POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y 97.BE-W366-4 09/29/2022 09/29/2023 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE ® OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ GEN1 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY �JEPRCT O- ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY Y 050 2980-C29-27K 09/29/2022 03/29/2023 CEa acOMBcidentINED SINGLE LIMIT $ BODILY INJURY (Per person) $ 500,000 ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ 500,000 PROPERTY DAMAGE Per accident) ccident $ 100,000 NON -OWNED HIRED AUTOS AUTOS A X UMBRELLA LIAR X I OCCUR 97-BE-W366-4 09/29/2022 09/29/2023 EACH OCCURRENCE $ 1,000,000 X rl AGGREGATE $ EXCESS LIAB CLAIMS -MADE DIED I X I RETENTION$ 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE 97-B1-B619-9 07/22/2022 07/22/2023 PER OTH- 1 ER E.L, EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N I A E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION CITY OF BLAIR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 218 S 16th Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Blair, NE 68008 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02-04-2014