HomeMy WebLinkAbout119633 MASEK GOLF CAR COMPANY - INSURANCE CERTIFICATE (5)PRODUCER INSURED'S COPY
FEDERATED MUTUAL INSURANCE COMPANY
Home Office: P.O. Box 328
a Owatonna, MN 55060
Phone: 507-455-5200
INSURED
MASEK DISTRIBUTING INC nr'� q
425 M STREET (Ol�'1 �1JpG1
GERING NE 69341
CERTIFYTHIS IS TO 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.
COI
LTR
$
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
DATE IMMIDD/YYI
DATE (MMIDD/YYI
GENERAL LIABILITY
GENERAL AGGREGATE
$
2 OOO 000
X
COMMERCIAL GENERAL LIABILITY
PRODUCTS - COMP/OP AGG
$
2,000,000
A
CLAIMS MADE � OCCUR
9088939
11/09/04
11/09/05
PERSONAL & ADV INJURY
a
1,000,000
OWNER'S & CONTRACTOR'S PROT
EACH OCCURRENCE
1 OOO OOO
AUTOMOBILE LIABILITY
X ANY AUTO
ALL OWNED AUTOS
A SCHEDULED AUTOS 9088939
X HIRED AUTOS
l X NON -OWNED AUTOS
11/09/04
FIRE DAMAGE (Any one fire)
$ 100,000
MED EXP (Any one person)
$
COMBINED SINGLE LIMIT
$ 1,000,000
11/09/05 IIIN
JURY NJURY I $
IPer BODILY
person)
BODILY INJURY I $
(Per accieentl
PROPERTY DAMAGE
$
GARAGE
LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN AUTO ONLY:
ANY AUTO
EACH ACCIDENT
8
AGGREGATE,$
A
EXCESS LIABILITY
X UMBRELLA FORM
9088940
11/09/04
11/09/05
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000.000
OTHER THAN UMBRELLA FORM
$
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
X WCV A U- OTH-
EL EACH ACCIDENT
$ 500,000
A
THE PROPRIETOR/
PARTNERS/EXECUTIVE INCL
024968
11/09/04
11/09/05
EL DISEASE - POLICY LIMIT
$ 500000
OFFICERS ARE: EXCL
EL DISEASE - EA EMPLOYEE $ 500,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESISPECIAL ITEMS
This copy is not to be reproduced for issuance of certificates.
A certiticate has been filed with eact
1�ertificateholder on the attached list.
PLEASE REVIEW THE LIST AND INFORM US OF
ANY CHANGES WHICH SHOULD BE MADE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMP/Il� ITS AOEfITS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIV / , /L