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A.✓ CERTIFICATE OF LIABILITY LIABILITY INSURANCE 07/2412 014 4
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).
CONTACT
PRODUCER NAME: Denis 'Vin
Omaha Insurance Services Inc. PHONE 402- 592-4455 FAX No) 402 -5924455
E-MAIL
11132 O Street Arc Ext
Omaha, NE 68137 ADDRESS:
Denis Vincent INSURER(S) AFFORDING COVERAGE NAIL k
INSURERA:Allied Property & Casualty 42579
INSURED Exterior Solutions Inc INSURERB:
Stephen & Kimberly Ram In INSURER C:
5708 Wlllit St INSURERD:
Omaha, NE 68152
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 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS.
rGENI'LAGGREGATE POLO E IDDIYYY F POLICY MMIDDIYYYY XP LIMITS
INSURANCE SD POLICY NUMBER MM
ENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
® occuR ACP3006736435 06/20/2014 06/20/2015 PREM E RENTED 50
DE PREMISES Ea occurrence
MED EXP (Any one person) $ 5,000
PERSONAL & ADV INJURY $ 1,00 0,000
IMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY ❑ PRO- LOC PRODUCTS- COMP/OP AGG $$ 2,000,000
AUTOMOBILE LIABILITY EaiacccideDiSINGLE LIIv11T $ 1,000,000
A 06120/2014 06/20/2015 BODILY INJURY (Per person) $
X ANY AUTO ACP3006736435
ALL OWNED SCHEDULED BODILY INJURY(Peraccident) $
AUTOS AUTOS PROPERTY DAMAGE
NON -OWNED Per accident $
HIRED AUTOS AUTOS
X UMBRELLA LIAB OCCUR - EACH OCCURRENCE $ 1,000,000
A EXCESS LIAB CLAIMS -MADE A CP3006736435 06/20/2014 06/20/2015 AGGREGATE $
$
DED RETENTION $ _
WORKERS COMPENSATION X STATUTE ER H
AND EMPLOYERS' LIABILITY
A ANY PROPRIETORIPAR T NERIEXECUTIVE YIN CP3006736435 06/20/2014 06/20/2015 E.L EACH ACCIDENT $ �
OFFICERIMEMBER EXCLUDED? N I p` 500,000
(Mandatory in NH} E.L. DISEASE - EA EMPLOYEE $
If yes, describe under E.L. DISEASE- POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
CITY046
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Blair
218 S 16th Street AUTHORIZED REPRESENTATIVE
Blair, NE 68008
O 1988 -2014 ACORD CORPORATION. All rights reserved.
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