Machine COL.tif SENTRY INSURANCE A MUTUAL COMPANY
STEVENS POINT, WISCONSIN
(A PARTICIPATING MUTUAL COMPANY)
A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES
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CERTIFICATE OF INSURANCE ACCOUNT NUMBER 24- 73818
This certificate is issued as a matter of information only and confers no
rights upon the certificate holder. This certificate does not amend,
extend or alter the coverage afforded by the policies below.
Name and Address of Name and Address
Certificate Holder of the Insured
CITY OF BLAIR MACHINE WORX INC
218 SOUTH 16TH ST. 147 COLFAX
BLAIR, NE 68008 BLAIR, NE 68008
This certificate is issued on 12 -19 -2011 and is effective until
12 -19 -2012. It certifies that policies of insurance listed below have
been issued to the insured named above. 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.
Coverage Provided Policy Number Coverage Limits
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General Liability 24- 73818 -01 General Aggregate $ 3
Products Aggregate $ 2,000,000
Bodily Injury and OCCURRENCE Pers /Adv Injury $ 1,000,000
Property Damage Combined Each Occurrence $ 1
Premises Damage $ 150,000
Medical Expense $ 10,000
Workers' Compensation 24- 73818 -02 Statutory
and Employer's Each Accident $ 1,000,000
Liability Each Disease /Employee $ 1
Each Disease /Policy $ 1,000,000
Should any of the above described policies be cancelled before the
expiration date thereof, notice will be delivered in accordance
with the policy provisions.
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80 -C1035 (MECH)
MAC 24 -73818 31- 082601 LDI COI 269628 -1 02 11
10 -21 -2011
PAGE 1
(0007)
05923
O1T160RG
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SENTRY INSURANCE A MUTUAL COMPANY
STEVENS POINT, WISCONSIN
(A PARTICIPATING MUTUAL COMPANY)
A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES
CE OF IN SURA NCE AC NUMBER 24 -73818
This certificate is issued as a matter of information only and confers no
rights upon the certificate holder. This certificate does not amend,
extend or alter the coverage afforded by the policies below.
Name and Address of Name and Address 1
Certificate Holder of the Insured
CITY OF BLAIR MACHINE WORX INC
218 SOUTH 16TH ST. 147 COLFAX
BLAIR, NE 68008 BLAIR, NE 68008
This certificate is issued on 12 -19 -2010 and is effective until
12 -19 -2011. It certifies that policies of insurance listed below have
been issued to the insured named above. 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.
Coverage Provided Policy Number Coverage Limits
General Liability 24- 73818 -01 General Aggregate $ 3,000,000
Products Aggregate 0 2,000,000
Bodily Injury and OCCURRENCE Pers /Adv Injury $ 11000,000
Property Damage Combined Each Occurrence $ 11000,000
Premises Damage $ 150,000
Medical Expense $ 10,000
Workers' Compensation 24- 73818 -02 Statutory
and Employer's Each Accident $ 110000000
Each Disease /Employee $ 11000,000
Each Disease /Policy $ 11000,000
Should any of the above described policies be cancelled before the
expiration date thereof, notice will be delivered in accordance
with the policy provisions.
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80 -0035 (SFA)
MAC 24 °73818 31- 082601 LDI COT 269628 -1 02 11
10 -21 -2011
PAGE 1
O1T19J N9 ,
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OCT -21 -2011 FRI 12:11PM ID:MACHINE WORX PAGE:2