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-> Proof of Insurance for Abe's Trash
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ACOR 7 &DATE
11iCERTIFICATE OF LIABILITY INSURANCE
(MMIDDNYYY)
2,24,2D21
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(les) must have ADDITIONAL INSURED provisions or 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
The Harry A. Koch Co.
P.O. Box 45279
Omaha NE 68145
CONTACT
NAME: Laurie SOpher
PHONEFAx
AICNo.Ex • 402-861-7273 A1C No): 877-991-8007
ADDRESS: lauHa.sapher@hakco.com
INSURER(SI AFFORDING COVERAGE NAIC #
INSURERA : Service American Indemnity Co. 39152
EACH OCCURRENCE $
INSURED ABE70379
INSURER B :
Abe's Trash Service, Inc.
8123 Christensen Lane
INSURERC:
INSURERD:
Omaha NE 68122
INSURER E :
$
INSURERF:
AUTOM 0 BILE LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY L AUTOS ONLY
COVERAGES CERTIFICATE NUMBER: 915039180 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.
1�TR
TYPE OF INSURANCE
ADD
S BR
POLICY NUMBER
MMIDDIYYYY
POLICY EXP
LIMITS
21B S 16
COMMERCIAL GENERALLIABILITY
CLAMS -MADE EIOCCUR
EACH OCCURRENCE $
DAMAGE TO
PREMISES Ea occurrence) $
MED EXP (Any one person) $
PERSONAL $ADVINJURY $
GEN'LAGGREGATE LIMIT APPLIES PER:
POLICY PRO- a LOC
JECT
OTHER:
GENERAL AGGREGATE $
PRODUCTS -COMP/OPAGG $
$
AUTOM 0 BILE LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY L AUTOS ONLY
COMBINED SINGLE LIMIT $
Ea accident
_
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
Per accident
$
UMBRELLA LIAB
EXCESS LIAB
Id
OCCUR
CLAIMS -MADE
EACH OCCURRENCE $
AGGREGATE $
DED I RETENTIONS
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
AWPROPRIErOR/PARTNER/EXECUTIVE YIN
OFFICEWM EMBER EXCLUDED?
(Mandatory in NH)E.L
If yyes describe under
DESG�RIPTIONOFOPERATIONS below
NIA
SAMTWC0029491
3/1/2021
3!112022
X STATUTE ER
E.L. EACH ACCIDENT $1,000,000
DISEASE -EA EMPLOYEE $ 1,000,000
E.LDISEASE- POLICY LIMIT $1,000,000
DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Service American Indemnity Co.
A. M. Best Rating = A- VIII
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2016103)
O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Blair
ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Brenda
AUTHI0,WZ9DREPRESENTATIV
21B S 16
Blair NE 68008
ACORD 25 (2016103)
O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD