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Skyline COL i 06/09/2014 14:50 4029945455 INSURANCE PAGE 02/02 I I k ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 06109/ 2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAMEN D, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TH 1w ISSVIN G INSURER(S), AUTHORIZED E REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: if the certificate h older Is an ADDITIONAL INSURED, the poliey(les) must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsem ent. A statem eni an this certificate does not confer rights to the certificate holderin lieu of such endorsem ent s . PRODUCER CONTACT USG Insurance Services, Inc. NAME 550 Main Street, Suite 270 PHONE x (A! G, Na, Ext): ( Al C, No): New Brighton, MN $511'2 EMAIL INSURER($) AFFORDING COVERAGE NAIL # INSURED INSURER A:Int'I Ins C o of Hanover 00213 INSURER B: Nicholas J Rayer Ir C. DBA Skyline Construction Services LLC INSURER D: 716 Beaver Lake Blvd P lattsm oath, NE 0804$ INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS iD TO CERTIFY THAT THE POUCIEe OF INSURANCE LIATE0 BELOW HAVE SEEN ISRUED 70 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWIIHSTANDINOANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHIOH THIS CERTIFICATE rAAY DE MSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIDEO Hr:REIN 19 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUOICS,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ILTR TYPE OFINSUF.ANCE INSR WV POLICYNUM[3t"R (MM1r)DJYY (MMJDD1YYYY) LIMITS GENERAL LIABILITY ACHO c NC , DAMAGE TO RENTED '100,000 )( COMMERCIALGENERALLIABILrrY PREMISES Eaoecurranee $ CLAMS MADE I I1. I OCCUR MED. E:F (Any one person) $ 5, A L � 1G08G0031ti1 0510112014 05!0112015 PERSONAL & ADV. INJURY $1,000,000 GFNFRALAGGREGATE $2,000, PRODUCTS•COMPIOPAGG. . $ I EN'L AGGREGATE LIMIT APPLIES PER' $ POLICY PRDJCCT LDC AUTOMOBILE LIABILITY (Eaw6 EDSINGLELIMIT $ (Ea aooldsnt) ANY AUTO BODILY INJURY(Perperson) $ ALL OVV4FDAUTOS BODILY INJURY (PeracclderIL) $ H iRED AUTOS PROPS !dent) AGE $ SCHEDULEDAUTOS (Poraccident} NON -O\WED AUTOS $ UMBRELLA LtA© OCCUR EACH OCCURRENCE EXCESS L LAS CLAVAMMAD AGGREGATE $ DED RETENTION $ $ KER SA IO N YIN LMlre oTH2A AND SMIPLOYRR'S LIABILITY $ ANY PRO PRIETORIPART6IER(EXECUTIVE E.L. EACH ACCIDENT OFFICEIM F.0 DER EXCLUDED? NIA (Mandatory In NH) RL, DISEASE- EAEMPLOYEE $ Iryea, do=raa Dndar DESCRIPTION OF OPERATIORSI 4AInv! EL, DISEASE -POLICYUMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (Attach ACORD 101, Additlonal Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION C ity of Blair, NE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 2 S 1 Sth Street EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE Blair, NEB8008 POL ICY PROVISIONS. UTHORIZED REPRESENTATIVE ACORDI S JM 0!0 AC OR 1 MRIPORATION 20