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Rodgers COL.tif i Server 12/2/2014 2:01:41 PM PAGE 1/002 Fax Server I Client #: 30968 RODGE _ AC TM CERTIFICATE OF LIABILITY T DATE (MM![}DIYYYY) 12/02/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR 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 NAME ACT Dee Kabourek INSPRO Insurance PHONE FAX 402 - 443 -3571 A1C No Ext : 402 =443 -3742 A/C NO). P.O. Box 336 ADDR dkabourek@insproins.com Wahoo, NE 68066 INSURER(S) AFFORDING COVERAGE NAIC# 402 443 -3742 INSURER A: Employers Mutual Insurance 21415 INSURED INSURER B: Rodgers Construction INSURER C 1951 County Road 17 INSURER D Colon, NE 68018 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 CONTRACTOR 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM /DD/YYYY MM /DD /YYYY A GENERAL LIABILITY 5D21553 1/01/2015 01/01/2016 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY PREMISES oocurrence $100,000 CLAIMS -MADE 7 OCCUR MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY 1$1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIESPER: PRODUCTS - COMP /OPAGG $2,000,000 POLICY PRO- LOC $ JECT A AUTOMOBILE LIABILITY 5E21553 1/01/2015 01/01/2016 COMBINED SINGLE LIMIT ( Ea 000,000 Ea accident , X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X HIREDAUTOS }( NON -OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION 5821553 1/01/2015 01/01/201 X WC ORT AMTS OR H AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE Y/N E.L. EACH ACC ID ENT $500,000 OFFICER /MEMBER EXCLUDED? ® NIA (M in NH) E.L. DISEASE- EA EMPLOYEE $500,000 describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $500,000 A Cargo 5021553 1/01/2015 01/01/2016 $10,000 Limit $50 I Deductible DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION City f Blair SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I AUTHORIZED REPRESENTATIVE ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD_ #S603880/M603862 AJW I