Guier COL.tif OP ID: SLM
° DATE (MM/DDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 10/27/11
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 pollcy(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).
CONTACT
PRODUCER
816- 333 -3000 NAME:
Robert E Miller Group 816 - 822 -1634 p "o Fax
373 W. 101st Terr, Suite 2QQ Arc No Ext : AIC No):
Kansas City, MO 64114 E-MAIL
Patrick Murphy PRODUCER
CUSTOMER ID #: GUIER -1
INSURER(S) AFFORDING COVERAGE HAIL #
INSURED Guier Fence Company INSURER A: Gener Casualty
2501 NW Jefferson St. INSURER B:
Blue Springs, MO 64015
INSURER C:
INSURER D:
INSURER E:
INSURER F
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 TYPE OF INSURANCE ADD S B POLICY EFF POLICY EXP LIMITS
1 SR WVD POLICY NUMBER MMIDDIYYYY MMIDDNYYY
GENERAL LIABILITY EACH OCCURRENCE $ 1
A X COMMERCIAL GENERAL LIABILITY CC10934342 01/31/11 01/31112 PREMISES Eaoccurrence $ 100,000
CLAIMS -MADE ® OCCUR MED EXP (Any one person) $ 5,000
PERSONAL &ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
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GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMPIOP AGG $ 2,000,000
P OLICY X PRO LOC $
JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,D ® 0,000
(Ea accident)
• X ANY AUTO CBA0934339 01/31/11 01/31/12 BODILY INJURY (Per person) $
ALL OWNED AUTOS BODILY INJURY (Per accident) $
SCHEDULED AUTOS
PROPERTY DAMAGE $ I
X HIREDAUTOS (Peracoident)
X NON- OWNEDAUTOS $
UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
4DEDUCTIBLE XCESS LIAR CLAIMS -MADE AGGREGATE $ 5,000,000
• CC U0934341 01131/11 01/31/12
$
ETENTION $ 10,004 $
WORKERS COMPENSATION X WC STATU- OTH-
AND EMPLOYERS' LIABILITY TORY LIMITS ER
A ANY PROPRIETOR/PARTNERlEXECUTIVE
YIN N CWC0934340 01131/11 01/31/12 E.L. EACH ACCIDENT $ 500,000
OFFICERfMEMBEREXCLUDED? � NIA
(Mandatory in NH) E.L. DISEASE -EA EMPLOYE 00
$ 500,0
If yes, describe under
DESCRIPTION0F0PERATIONSbelow E.L. DISEASE - POLICY LIMIT $ 500
DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
Reference: Mike Borer
CERTIFICATE HOLDER CANCELLATION
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Blair THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
218 S 16th St ACCORDANCE WITH THE POLICY PROVISIONS.
Blair, NE 68008
AUTHORIZED REPRESENTATIVE
O 1988 -2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
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