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Weatherguard COL.tif i I G 11/13/2015 1:28 PM Applied Systems,Inc >City of Blar 01 ACQRD� DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 11/13/2015 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 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 Darcy Barry Grace/Mayer Insurance Agency,Inc PHONE 402-397-5050 FAX 402-397-6675 Gallagher Grace Mayer (A/ No Ext), A1C No IL 10050 Regencjv Circle,Suite 300 .Da Omaha NE 68114 INSURER($)AFFORDING COVERAGE NAIC11 INSURER A:Columbia National Insurance Company 19640 INSURED INSURER B: Weatherguard InG. INSURER C: 11440S 146th St.,Ste#101 Omaha,NE 68138-6519 INSURER Q INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 401763712 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. !LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MMIDDIYYYY LIMITS A X COMMERCIALGENERALLIABILITY CMPNE0000014344 1115/2015 11/15/2016 EACH OCCURRENCE $1,000,000 CLAMS-MADE ❑X OCCUR PREMISES Ea occurrence $100,000 MED EXP(Any one person) $6,000 PERSONAL&ADV INJURY $1,000,000 i GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICYX❑JECT 1-1 LOC PRODUCTS-COMROP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY CAPNE0000014344 11115/2015 11/1512016 Eaaccident $1,000,000 X ANY AUTO BODILY INJURY(Perperson) $ AUTOS NED SCHEDULED BODILY INJURY(Peraccident) $ UTO NON-OWNEDFKUI'tAGE $ HIREDAUTOS AUTOS Peraccident A X UMBRELLA X OCCUR CUPNEODOOO14344 11/15/2015 11115/2016 EACH OCCURRENCE $1,000,000 EXCESSLIAB CLAIMS-MADE AGGREGATE $1,000,000 DED I X I RETENTION$10,000 $ A WORKERS COMPENSATION WCPNE0000014344 1115/2015 11115/2016 X STATUTE ERH � AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑NIA E.L.EACH ACCIDENT $600,000 OFFICER/MEM BER EXCLUDED? (M andatory in NH) E.LDISEASE-EAEMPLOYEE $500;000 If yes,describe under DESCRIPTION OF OPERATIONS below E-L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached It more space Is required) CERTIFICATE HOLDER CANCELLATION i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Blair ACCORDANCE WITH THE POLICY PROVISIONS. 218 So 16 St Blair NE 68008 USA AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks ofACORD