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Policy Number: A03070;m Date Entered: 04/04/2014 �
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CERTIFICATE F LIABILITY INSURANCE DATE (� 014 "'
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: It the certificate holder is an ADD1116NAL INSURED, the poliey(ies) must be e ndorsed. If SUBROGATION IS WAIVED, subject to
the terms and cond itions of the policy, certain policies m require and el'ItlOi'OEment, A. sUftment on this certificate does not confer rights to the
Iiortifiicats holder in lieu of such endorsement(s).
P RODUCER CONTACT
Pam C"a NAMCz
PHON
ISO 130X 2 E FAI (a172) 9bY5B 9 N4: (402) 296 -2626 ,
316 CHICAGO AVn A F'
PLATTS2+Or. TH NE 68448 INSURERS G0 AFFORDING COVERAGE _ NAI
INSURER A! r MUTUAL -
INsuRro Lockman Enterprises, Inc. 1NSUREA8:
INSUR 0. r _
21901 1E igliview St INSURER D,
INSURER F ;
COVERAGES CERTIFICATE NUMBER REVISION NUMBER:
THIU 1.5 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED EELQW HAVE BEEN 119SUEU I'U I HE 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 $I- ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
ADDILI 411.18 �L• R TYPE OF INSURANCE poijo1f NUMBER MM/Dta EFF MwooryYYY - LIMIT$
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
GOMMtRC1ALGIMNERALLIAOILITY 1'}0005520e�] i<lbif301d SJOij2015 PR E3CLamwflu va) `V100 000 QAMAqF_TQRe D_
CLAIMS -MADE � OCCUR MED EXR (Any one person)
PERSONAL & ADV INJURY - $
GENERAL AGGREGATE $2t00
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - OOMPIOP ACG $2/000,000
POLICY F7 PRO- D LOC -
AIJT0MOIKF LIABILITY CO MBINED 4iNGIJ.- LI MIT
jggAa cidantl $ „ -•
ANY AUTO BODILY INJURY (Par person) $
AUTOS NPIS AUt h r BODILY IwuRY (Ppr -jtti IL - -
HIAGO AUTOS
N OWNED R P r�acddent �
UMBRELLA LIAR OCCUR EACH OCCURRENCE L $ _
EXCESS LIAR H OLAIMS-MADC AGGREGATE „
DCD P=hITION $
WISRKE'RS 4OMPENSAI'ION WC STATU- I IQTH-
AND EMPLOYERS' LIABILITY Y t N TORY JT "
ANY PROPRI ETORIPARTNQR!$XF,Ct)TIVE E,L, EACH ACCIDENT $
OFFICERIMEM9ER EXCLUDED? E7 NIA
(Mandatary in NH) T_L. onsmist - to tMPLOYEE _
If yy dastdba under
DESG QF QPERATIQNS halow E.L. DISEASE - POLIOY LIMIT $
DESCRip - nON OF Opp; A7 dmt.I LOCAMONS I VEHICI 9 (Attach a? CORD 107, Addldonal Ramarict Sth4dulo, If More space Is regUirecl)
CE RTIFICATE HOLDERR CANCELLATION
SHOULD ANY OF THE ABQVF, DESCRIBED POLICIES OE CANCELLED BEFORE
City Of Blair ACCORDA GE WITH THE OLICY PROVISIONS, NOTIC WILL HIE DELIVERED IN
210 s 16 St
Blair, Ne 68008 RFZWtf+EPRFSENTATIVF_
Q 1988 -2010 ACORD CORPORATION. All rights reserved.
ACOkD 26 (201010$) The ACORD n2mQ 2nd logo are registerAd market of ACORD
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