Monarch COL.tif APR /0$ /2015 /WED 03:07 PM Byers Insurance FAX No, P,001 /001 j
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MONAR -1 OP ID. JJ
ri CERTIFICATE O L IABILITY INSURA DAT E(MMI9DAYWI
04/0812016
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.
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IMPORTANT: If the certiflcata holder Is an ADDITIONAL INSURED, the pollcy(,es) roust be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and cenditibn► i of the policy, certain policies may require an aridorsem€nt. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUOER RONTAOT
Byers Insurance A NAME_ Dan B ers or Julie Ifroskc�
y Agenc 'H
enc ONfi FAK
18214 CottnQr Street Ar Na Ext : 402 - 397 -4250 Arc Nn : 402 - 397 -2591
Omaha, NE 8$1$7 -1777 AD DRESS, Don Byers SS, 'uliek b ers.0mha0xmail.earrl
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INSURE S AFFORDING COVERAGE NAIL #
INSURERA:Columbia In surance Group 40371
INSURED Monarch Sidi & Windows Inc INSURER B: j
308 East Gary St, INSURERC:
Papllllon, NE 68046 -2031
INSURER 6 -
INt3URER E
INBURER 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I NSM ADDL SUSR POLICY EPP POLICY ECP
LTR TYPE OF INSURANCE IN S E] WV13 POLICY NUMBER NOWDWYYYY ( MM-DIYYYY LIMIT5
A X COMMERCIAL OPNERAL LIABILITY EACH OCCURRENCE $ 1,000,00
CLAIMS -MADE OCCUR CMPNE1145$ 12I15/2014 1211512015 PREMISES ..r'.Uffdncd S 100.00
MED EXP (Any one person) $ 5
PERSONAL & ADV INJURY 5 1
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GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00
POLICY ❑ JECT LOC PRODUCTS COMPIOPAGG $ 2,000,00
OTHER- S
COM
AUTOMOBILE LIABILITY 6INED SIN L LIMIT $ 1,000,00
Ea ERNED
A ANYAUTO CAPNE11458 1211512014 1 2/15/2015 BODILY INJURY (Pr person) $
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ALLOWNEQ SCHEDULED BODILY INJURY (Per moldent) $
AUTOS
X HIRED AU TOS AQ 03WNED P ROPERTY DAMAGE S
UMBRELLA LIAS H occuR EACH OCCURRENCE $
ACCESS LIAM CLAIMS -MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION X P TAT TE ER
AND EMPLOYERS' LIABILITY
A ANY PROPRIETORIPARTNEIEXECUTIVE YIN
R WCPNE114558 12116/2014 1211512015 E.L. EACH ACCIDENT S 100,000
OFFICERIMEMBERFXCLUDED9 a NIA
(Mandatary In NH) E.L. DISEASE -EA EMPLOYEE $ 100,00
if yes, asecrlbe under
DESCRIPTION OF OPERATIONS belOW E,L, p)SEASE - POLICY LIMIT $ 600.00
DESCRIPTION OP OPERATIONS I LOCATIONS I VEHICLES (ACORD 107, Adc ltional Pon arks Schedulb dW be attached If mare Won 1s required)
CERTIFICATE HOLDER CANCELLATION
G1TYRLA
SHOULD ANY OF THE AUCIVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Blair ACCORDANCE WITH THE POLICY PROVISIONS.
218 S 16th St
Blair, NE 68008 AUTHORIZED REPRE$ENTA'nVE
(11988 -20'14 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
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