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201403427 AC RD® `+ DATE 4611MIYYYV) �, CERTIFICATE OF LIABILITY INSURANCE 03/14/2014 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 lieu of such endorsement(s). PRODUCER I CONE CT Matthew Myers Matthew Myers PHOO.NN,E;U: (308)234-4922 rec.nor 5810 2nd Ave W E-MAIL _ _ ADDRESS: Kearney,NE 68845 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Farm Bureau Property&Casualty Insurance Co. 13773 _... _ _... -_, INSURED - -- -- INSURER B: Michael Panow(cz/Matthew Panowicz I INSURER C: 10288 W.White Cloud Rd. I INSURER D: Cairo,NE 68824 I INSURERS: I 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. INSR ADDL SlieR -- LTR TYPE OF INSURANCE I IN SD WVD POLICY NUMBER POLICY EFF POLICY YY $ (MMlDD/YYYI')I MOD ' .. „LIMITS COMMERCIAL GENERAL LIABILITY I —I EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED _ CLAIMS-MADE (�OCCUR PREMISES(Ea axurzencel S X Farm Liability I MED EXP(Arty one person) $ 7747809 02/01/2014 02/01/2015 I PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ POLICY I I JET .II LOC I PRODUCTS-COMP/OP AGG I$ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea acddantl _ ANY AUTO I BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ __ AUTOS AUTOS I ( )I __ HIRED AUTOS I NON-OWNED PROPERTY DAMAGE S AUTOS (Per accident) $ — UMBRELLA LIAR I OCCUR EACH OCCURRENCE $ EXCESS UAB I CLAIMS-MADE AGGREGATE $ DEO I I RETENTION S I i $ WORKERS COMPENSATION IATUTE I I ER AND EMPLOYERS'LIABILITY Y/N ---- - ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ i OFFICER/MEMBER EXCLUDED? pi I A IMandatory In NH) EL DISEASE-EAEMPLOYEE S H yyeess describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I S DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached',more space is required) 1 CERTIFICATE HOLDER CANCELLATION , 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN State Property Program Management ACCORDANCE WITH THE POLICY PROVISIONS. Paula Sedlacek 1526 K Si.Ste.200 i AUTHORIZED REPRESENTATIVE 4/4/Lincoln,NE 68508 0 9: r`0 4 AC•-e C%r.ORA ION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORb