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AUG -07 -2014 11:40 JOE VUKOV RE & INSUR AGCY 402 731 9719 P.001 /001
DATE (MMIDDIYYYY)
A V CERTIFICATE OF LIABILITY INSURANCE O$Ip712014
THIS CERTIFICATE 1$ ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT$ 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 Certificato holder Is an ADDITIONAL INSURED, the policy(les) must be ondor"d. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endarsomenG A statement on this certificato does not confer rights to the i
certificate holder In lieu of such endorsement(s).
PRODUCER C RAMP ACT MarkAVukov
ONE aIC Ne:
Joe Vukov Real Estate & Insurance Agency, Inc P ar H c No 402 -735 -4317 40 2-731 -0718 _ADIR F- MA'65: mavukov@joevukov.com
x238 L Street
423 8ha, NE t d7 INSURER($) AFFORDING COVERAGE NAIL #
INSURERA: FimtGomp Insurance Co
INSURED INSURER 8
Logui Siding Inc iNSURERG:
5112 Jefferson Street INSURER D
Omaha, NE 68117 -2762 INSURER E:
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS I$TO CERTIFY THAT THE
NY G ANY REQUIREMENT, TERM OR POLICY
OR COND TION F ANY CONTRACT R OTHER DOCUMENT WITH RESPECT TO
INDICATED. WHICH THIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE WVb POLICY NUMBER MMfDD MMIt}DIY LIMITS
COMMERCIAL GEMPRAL LIABILITY EACH OCCURRENCE KI: L
CLAIMS -MADE FI OCCUR PREMISES Ea 0rcurrenee
MED EXP (Ally 0118 09r60n)
LTR
PERSONAL $ADV INJURY
CEN'LAGGREGATE LIMTAPPLIES PER: GENERAL AGGREGATE $
POLICY JECr LQC PRODUCTS CONE' /OPAGG a
OTHER:
S
AIJTOMOBILELLABILITY Eamccident
A BO61LY INJURY (Per perw -) $
ALLL L O OWN WNED SCHEDULEQ BODILY INJURY (Per accident) $
AUTOS AUTOS PLRTY =73T
NON - OWNED parncdelmnl S
HIRED AUTOS AUTOS
UMSRELLALIAB OCCUR EACH OCCURRENCE $
EXCESS DAB CLAIMS-MADE AGGREOAfE
QED RETENTION$
WORKERSCOMp4NSATION s ruTE ER
AND EMPLOYER$' LIABILITY
Y
ANY PROPRIETORIPARTNERIEXECUTIVE ❑ NIA WC0137140 -02 06/27/2014 06/2712015 EL FACHACCIDENT PLOYEE 100.00
A OFFICE REM @ER EXCLUDED? $ 100,000
(Mandatory in NH) E.L. QI$EASE - FA CM
If Yyes, tlea0rl69 under E.L. DISEASE - POLICY LIMIT $ 506,000
aESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VPHICLES (ACORD 169, Additlbnal Rgmarke Schedule, may be attached If Mora space i's required)
I
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DE$GRIBED POLICIES BE GANCEI,L.EO BEFORE
THE EXPIRATION DATE THEREOF, NOYICE WILL BE DELIVERED N
ACCORDANCE WITH THE POLICY PROVISION$.
Select Siding and Windows
5030 S 128th Street AUTHORIZED REPRESENTATIVE /
Omaha. NE 68137 Mark A Vukov .4./
natehegiQhotmail.0oM
b 19$8-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registorod marks of ACORD
TOTAL P.001