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TotalRo COL.tif f i0or CERTIFICATEDATE(MM/DD/YYYY) OF LIABILITY INSURANCE 6/24/2015 IS 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 CL Associated Underwriters NAME: Associated Underwriters, Inc. PHONE Ext): (402)592-0900 FAC No: (402)592-0962 C-TEK Insurance A E-MAIL Agency y ADDRESS:CL@aunderwriters.com 9412 Giles Road INSURER(S)AFFORDING COVERAGE NAIC# La Vista NE 68128 INSURERA:Iowa Mutual Insurance 14338 INSURED INSURER B:Nationwide Mutual Ins Co. 23787 BradCo Construction Inc DBA: Total Roofing INSURERC:Swett & Crawford 10501 Chandler Circle INSURER D: Suite 100 INSURER E: I LaVista NE 68128 INSURER F: COVERAGES CERTIFICATE NUMBER:15/16 ALL CERTS! 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. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE W OCCUR DAMAGES( RENTED 100,000 PREMISES Ea occurrence $ A028984NN 6/16/2015 6/16/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO JECT ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Employee Practices Liability $ 100,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS ACP7254414446 3/23/2015 3/23/2016 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident Uninsured motorist combined $ 1,000,000 A X UMBRELLA LIAB OCCUR A028984MN 06/16/2015 06/16/2016 EACH OCCURRENCE $ 2,000,000 B EXCESS LIAR HCLAIMS-MADE AGGREGATE $ 2,000,000 DED RETENTION$ ACP7254414446 3/23/2015 3/23/2016 OCCURENCE/AGGREGATE $ 1,000,000 C WORKERS COMPENSATION AVWCNE2340872015 10/02/2015 10/02/2016 X PER AND EMPLOYERS'EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 B LEASED/RENTED ACP7254414446 3/23/2015 3/23/2016 50,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) I i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Blair THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 218 S. 16th Street ACCORDANCE WITH THE POLICY PROVISIONS. Blair, NE 68008 AUTHORIZED REPRESENTATIVE Greg Gurbacki/CG ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)