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NebraskaS COL.tif A © - CERTIFICATE F LIABILITY INSURANCEDATE(MMIDD/YYYY) 9/3/2015 } RTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CE"FICATE 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 NAME: Dorothy Johnson AX PHONE Smith Davis Insurance _"A, No,_Ext): 712)322-1600 (A/C,No): (712)322-9204 532 First Avenue E-MAIL-ADDRESS: -MAILADDRESS: �' dohnson@smithdavisinsurance.com P O Box 528 INSURER(S)AFFORDING COVERAGE NAIC# Council Bluffs IA 51503 INSURERA:UNITED FIRE & CASUALTY 13021 INSURED INSURERS: Hawkeye/Nebraska Siding Window and Door Inc INSURERC: 17622 Sunnydale Road INSURER D: ---------- INSURER E: Council Bluffs IA 51503 INSURER F: ! COVERAGES CERTIFICATE NUMBER:15/16 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. INS - ADDLiSUBRj - POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY1 (MM/DDNYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A CLAIMS-MADE �X J OCCUR PREMISES Ea occurrence $ 100,000 60408355 10/1/2015 10/1/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X 1 POLICY D'JE� 11 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 1 OTHER: Internet Security $ 25,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 A ANY AUTO BODILY INJURY(Per person) $ ~'ALL OWNED SCHEDULED ( ( ) $ X 60408355 10/1/2015 10/1/2016 BODILY INJURY Per accident AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident) $_ Medical Expense $ 5,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED X RETENTION$ 0 60408355 10/1/2015 10/1/2016 $ WORKERS COMPENSATION j PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A -- -- _. (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) i i CERTIFICATE HOLDER CANCELLATION (402)426-4195 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 ST ACCORDANCE WITH THE POLICY PROVISIONS. BLAIR, NE 68008 AUTHORIZED REPRESENTATIVE James Malone/DOR ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)