Loading...
HomeMy WebLinkAboutMasek Distributing Inc. - INSURANCE CERTIFICATEFrotrl:Nora A. Lee, CISR FaxID:314-231-4482 Page 2 of 2 Date:2/2/2009 04:39 PM Page:2 of 2 s ACORD OP ID NL DATE (MMDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE MASEx-1 02/I03/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Richard Maxedon ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE C.J. Thomas Company, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 800 Market Street, 18th Floor ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. St. Louis MO 63101 Phone:314-231-1717 Fax:314-231-4482 INSURED Masek Distributing, Inc. New Ports LLC 425 M St Auilding 1 Gering NE 69341 COVERAGES INSURERS AFFORDING COVERAGE NAIC # INSURER A: National Fire 20478 INSURER B: Continental Insurance 35289 INSURER C: Accident Pund Insurance Co. 10166 INSURER D: Continental casualty company 20443 INSURER E: 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . LTR !NSRE TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X X COMMERCIAL GENERAL LIABILITY CNP4012387759 11/09/08 11/09/09 PREMISES (Eaoccurence) $ 300,000 CLAIMS MADE 7 OCCUR _ MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 - GENERAL AGGREGATE $ 2 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OPAGG $2,000,000 X I POLICY PRO- JECT LOC B X AUTOMOBILE X LIABILITY ANY AUTO BUA4012387731 11/09/08 11/09/09 COMBINED SINGLE LIMIT (Ea accident) $ 1 , 000 , 000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1,000,000 D X I OCCUR ❑ CLAIMSMADE CUP4012387762 - 11/09/08 11/09/09 AGGREGATE $ 1,000,000 $ DEDUCTIBLE X RETENTION $ 10000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE WCV6050318-0 11/09/08 11/09/09 X ITORY LIMITS ER E.L. EACH ACCIDENT $500 000 E.L. DISEASE - EA EMPLOYEE $ 500 , 000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500 , 000 OTHER D Equipment Floater IM4012163258 11/09/08 11/09/09 Golf Cars $2,167,000 Ded. $2,500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS City of Ft. Collins, its officers, agents and employees are included as additional insured in regards to the auto liability and general liability in regards to the contract with the named insured. GEIRTIFIGATE HOLDER CANCELLATION CITYOFF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Ft Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Attn : Jim Hume NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL P.O. Box 580 215 N . Mason St 2nd Floor IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Ft. Collins CO 80522-0580 REPRESENTATIVES. ACORD 25 (2001/08) © ACORD CORPORATION 1988