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,~~w~~ 2 010 014 8 ~ <br />~~"~y., 7 ~ DATk (MM/DD/YYYY) <br />CERTIFICATE OF LIABILITY INSURANCE oz/o5/zolo <br />PRODUCER HERITAGE INSURANCE -WOOD RIVER THIS CERTIFICAT<= IS ISSUED AS A MATTER OF INFORMATION <br />BOX 487 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />WOOD RIVER NE 68883 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Phone: 308-583-2262 Fax: 308-583-2416 <br />INSURED <br />Andrew Monson <br />11700 W WILDWOOD DR <br />WOOD RIVER NE 68883-9445 <br />INSURERS AFFORDING COVERAGE ~ NAIC # <br />INSURERA: ALLIED INSURANCE ~ _. ___ <br />INSURER B: <br />INSURER C: <br />INSURER D: <br />INSURER E: <br />vv v ~r~n..-. ~.r <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />ANY REQUIREMENT <br />, <br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />MAY PERTAIN <br />, <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED 8Y PAID CLAIMS. <br />INSR DD' POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ ~ ,000,OOO <br /> DAMA <br /> GDMMERCIAL GENERAL LIABILITY PREMIS urrence $ <br /> CLAIMS MADE ~ OCCUR MED EXP (Any one arson $ 5,000 <br />A x FARM LIABILITY FPK FMP 7271214097 08/26/2009 08/26/2010 PERSONALBADVINJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,OOD,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRGDUCTS - COMPIDP AGG $ 1,000,000 <br /> <br /> POLICY PRO- LDC <br /> <br /> AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT <br />$ 1,D00,000 <br /> ANY AUTO (Ea accident) <br /> <br /> x ALL AWNED AUTOS BODILY INJURY $ <br /> SCHEDULED AUTOS (Per person) <br />A FPK FMP 7271214D97 08/26/2009 08/26/2010 <br /> HIRED AU70S BODILY INJURY $ <br /> NON-OWNED AUTOS (Per accident) <br /> <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTD ONLY: AGG $ <br /> EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> OCCUR ~ CLAIMS MADE AGGREGATE $ <br /> <br /> <br /> DEDUCTIBLE $ <br /> <br /> RETENTION $ $ <br /> WORKERS COMPENSATION WC STATU- DTH- <br /> AND EMPLOYERS' LIABILITY Y / N <br /> ANY PROPRIETORlPAR7NER/EXECUTIVE E.L. EACH ACCIDENT $ <br /> ^ <br />OFFICER/MEMBER EXCLUDED9 <br />(Mandatory In NH) <br />E.L. DISEASE - EA EMPLOYE <br />$ <br /> If yes, describe under <br />SPECIAL PROVISIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$ <br /> OTHER <br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES / EXCLUSIANS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS <br />AddltlDnal Insured: State of Nebraska <br />AS/State Building Division <br />PO Box 98940 <br />Lincoln, NE 68509-8940 <br />r•nw~rc~ r nT~rvu <br /> SHOULp ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />State of Nebraska DATE THEREOF, THE 1$5UING INSURER WILL ENDEAVOR 70 MAIL 3D DAYS WRITTEN <br />As/State Building Division NOTICE TD THE ~FR*IrJ~ATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO 8HALL <br />R <br /> IMPOS~ OBLIGATIO OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS O <br />Attn; Leasing Coordinator <br /> REP ESENTATIVES. <br />PO Box 98940 A HORIZED REPR Er~TATIVE <br />Lincoln, NE 68509-8940 ~,`~ <br />ACORD 25 (2009/01) u/ lyoo-cvura rya. ~ vvnrvr..~y....,.. r,,, ..a................... <br />The ACORD name and logo are registered marks of ACOR <br />