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CERTIFICATE OF INSURANCE <br />~• <br />2oioo3si5 <br />Name & Address To Whom Issued: <br />STATE OF NEBRASKA <br />:: STATE BLDG DLVISION <br />LEASING COORDINATOR <br />- PO BOX 98940 <br />LINCOLN, NE 68509-8940 <br />SHELTER MUTUAL INSURANCE COMPANY <br />A MUTUAL COMPANY <br />SHELTER GENERAL INSURANCE COMPANY <br />A STOCK COMPANY <br />Name & Address of the Insured: <br />GARY & DEBORA HOUDEK <br />1055 4Tx RD <br />CHAPMAN, NE 68827-2735 <br />This is to certify that insurance policies as indicated below by policy number have been issued: <br />Company Type of Insurance Policy Number Expiration bate Limits of Liability <br /> General Liability: <br />Shelter Premises & Operations <br />___T_ Per Occurrence Aggregate * <br />Mutual Products/Completed <br /> Operations Provided? Products/Completed Operations For: (Describe) <br /> Yes _ No <br /> <br /> * The Limits of Liability for any indicated General <br /> Liability policy are the limits at the time the policy is <br /> - issued. The aggregate limit is, and other limits may <br /> be, reduced by the amount of claim payments. <br />Shelter Single Limit <br />General Garage Liability BI Fer Person <br /> BI Per Accident PD Per Accident <br />Shelter Automobile Single Limit <br />Mutual All Owned or Leased Autos BI Per Person <br />_ Scheduled Autos <br />~ BI Per Accident PD Per Accident <br />Shelter _ <br />Hired Autos <br />General - <br />Non Owned Autos <br />Shelter Apartment Owner's/ Per Occurrence <br />Mutual Rental Dwelling Per Aggregate <br />Shelter Business Per Occurrence <br />Mutual Per Agge~te <br />Shelter <br />Mutual Car o -Scheduled Auto/Trailers <br />B <br />Per Vehicle <br />~/' Shelter <br />/~ Mutual <br />Shelter PERSONAL & FARM <br />LIABILITY 26-32-4018819-1 02/19/2011 1,000,000.00 <br />General <br />Year Model <br />VEHICLE(S) <br />Trade Name <br />Motor Serial No. (Last 5 Digits) <br />This Certificate of Insurance neither afiiimatively nor negatively amends, alters or extends the wverage afforded by the policy. <br />Date 04/13.2010 <br />Auth epresetilamve <br />M-51.24-M <br />1817 WEST BROADWAY • COLUMBIA, MISSOURI.6S218-0001 • (573) 445-8441 <br />