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DM-2012-00549_0004.tif FromWelissa Munsterman FaxID:Maguire Agency Page 2 of 2 Date: 11f7/2012 03:48 PM Page:2 of 2 i OP ID: MD TIF OF LIABI LITY I DATE 11071 iYYYY) 11!07/12 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(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 Ileu of such endorsement(s). PRODUCER 651 - 638 - 9100 NAME: - Maguire Agency PHONE FAX 1935 West County Road B -2, #241 651- 638 9762 qIC L Ext : A1C No Roseville, MN 55113 ADD E Housemovers PRODUCER CUSTOMER ID #: LANG E -1 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Lange House, Building INSURERA:Travelers Insurance Companies 24775 Charles Lange DBA - INSURER B: and Bin Movers INSURER C 113 Neff Street Scribner, NE 68057 INSURERD: INSURER E: INSURER 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. POLICY EFF POLICY EXP ADM ILTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 6606788MO76 02/28112 02/28/13 PREMISES Ea occurrence $ 100,000 CLAIMS -MADE OCCUR MEDEXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP /OP AGG $ 2,000,000 PRO- $ POLICY X EC LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 02128!12 02/28/13 (Ea accident) • X ANY AUTO BA3687C080 BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON -OWNED AUTOS $ UMBRELLALIAB H OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- O R AND EMPLOYERS' LIABILITY TORY LIMITS ER ANY PROPRIETORIPARTNER/EXECUTVE Y� N I A E.L. EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS below • Cargo 6606788MO76 02/28/12 02/28/13 ACV up to 125,000 1,000 Ded. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ' i CERTIFICATE HOLDER CANCELLATION XBLAIRZ 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. 218 South 16th Street Blair, NE 68008 AUTHORIZED REPRESENTATIVE �L O'k ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD