MS-20122-00400_0004.tif p,2
F CERTIFICATE OF LIA► ILI INKS U NaCE DATEIMM(DDIYYYY)
0 9 / 21 / 2 01.2
A� 192 Insurance -- Joe Peleska, Agent N YCAND F CON ERS I NO U RIGHTS UPON THE CERT FCA MR I I E
9 68000 3 0 St HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
69 ALTER THE COVERAGE AFFORDED 9Y THE POLICIES BELOW.
I INSURERS AFFORDING COVERAGE NAIC #
INSURER A: State Farm Fire and Casualty Company 25143
Micheal Tea er 25193
g INSURER B:
DBA All American Pro INSURER C:
12355 Ann Dr
Blair, Ne 68008 -7510 INSURER D.
COVI_RAGES INSURER E:
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 WH1CH 7H IS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES- OF
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSR ADcrL
LiR TYPE OF INSURANCE POLICY EFH VE POLICY EXPIRATION
POLICY NUMBER DATE(MMIDDIYY DATE[MI
NDDIYY)
A GENERALLIABILrry 917 — W 4-4 F 09!15%2012 G9/15%2U13 EACH OCCURRENCE 1, 000 no-0
_
$ ,
X COMMERCIAL GENERAL LIAJ3lLITY D A TO NT
CLAIMS MADE OCCUR PREMISES Ea occurrence $
MED EXP An one son} $ 5, 000
PERSONAL & ADV INJURY $
C fLAGG GENERAL AGGREGATE $ 2,000,000
PRO- PRODUCTS- COMP)OPAGG S 2,000,000
X POLICY JECT LOC
A AUTOMOBILE LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT $
ALL OWNED AUTOS (Ea accident)
SCHEDULED AUTOS BODILY INJURY
(Per person) $
HIRED AUTOS
NON -OWNED AUTOS BODILY INJURY
(Peraccident) $
PROPERTY DAMAGE
{Pereocident) $
GARAGE LIABILITY
ANY AUTO
AUTO ONLY— EAACCIOENT $
OTHER THAN EA ACC $
AUTO ONLY:
'EXCESS/UMBRELLALIABILITY AGG $
X OCCUR 0 CLAIMS MADE EACH OCCURRENCE $
AGGREGATE $
DEDUOT18LE
X RETENTION $ 10, 000 $
A WORKERS COMPENSATION AND S
EMPLOYERS' LIABILITY WC STATU- OTH-
ANY PROPRJETOPJPARTNERIEXECUTIVE ` TORY LIMITS i ER
OFFICERIMEMBER EXCLUDED? E EACH ACCIDENT $ under
SPECIAL desPROVISIO NS belcw EL DISEASE - EA EMPLOYEE $
SC PROVISIONS
OTHER E.L. DISEASE- POUCYLIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVJSIONS
Construction
CERTIFICATE HOLDER CANCELLATION
CITY OF B:�AIR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E7QryRp710N'.
218 S 1 G Sm DATE - 1 EREDF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _
BLAIR, NE 68008 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAIL 7o DO SO SH
FAX: 402 -429 -4195 IMPOSE NO OBLIGATION OR LIABILFTY OF ANY KIND UPON THE
IN R ITS AGE S qq R PRE2tN TATI S.
A THO !ZED REP t; 7
132849 03 -i3 -2007 a reglS ra Ion no ICES In ICa E owners Ip o s y elr �r�e�spe / Ive o n o
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