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K2 COL.tif Client #: 62527 K2CON DATE (MM /DD/YYYY) A h, CERTIFICATE F LIABILITY INSURANCE 12/27/2011 THIS CEOFICATE 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 Tonya Wagner INSPRO Insurance a/c °, "N E FAX AIc N 402 - 483 -7977 P.O. Box 6847 E -MAIL ADDRESS: twagner ner roins.com Lincoln, NE 68506 INSURER(S) AFFORDING COVERAGE NAIC # 402 483 -4500 INSURER A Bituminous INSURED INSURER B: K2 Construction j -- INSURER C 7701 Cornhusker Highway INSURER D Lincoln, NE 68507 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 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM /DD /YYYY MM /DD YY A GENERAL LIABILITY CLP3551094 1/0112012 01/01/2013 EACHOCCURRENCE $1 3 000,000 I COMMERCIAL GENERAL LIABILITY PREMISES (Ea occur nce $ 300,000 CLAIMS -MADE � OCCUR MED EXP (Any one person) $ 5,000 PDDed:2,000 PERSONAL& ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY X PRO LOC $ JECT • AUTOMOBILE LIABILITY CAP3551149 110112012 01101/201 Ea acccic."') SINGLE LIMIT 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS $ X HIRED AUTOS X NON -OWNED PROPERTY DAMAGE AUTOS Per accident X Drive Oth Car $ • X UMBRELLA LIAB X OCCUR CUP2589435 1/01/2012 01/01/2013 EACH OCCURRENCE $5, 000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE s5, 000,000 DED XT RETENTION $10000 $ STATUS A WORKERS COMPENSATION WC3551065 1/01/2012 01101/201 X -- WC ORH- AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N E.L. EACH ACCIDENT $500 OOO OFFICER/MEMBER EXCLUDED? NJ N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $5 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Named Insureds: K2 Construction; K2 Real Estate Development, LLC; Sapper Construction, LLC; Mount Godwin, LLC; Standing Rock Construction; City of Blair, Water Line Improvements 2011, Blair, NE HGM Project No. 70409 I I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Blair THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 218 South 16th Street ACCORDANCE WITH THE POLICY PROVISIONS. Blair, NE 68008 AUTHORIZED REPRESENTATIVE I cam° ► +�� .�.. �6�G- d © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S359537/M359482 TSN