HomeMy WebLinkAboutFIRST NATIONAL OF NEBRASKA INC - INSURANCE CERTIFICATE (2).,'a DATE (MM/DD/YYYY)
coRo CERTIFICATE OF LIABILITY INSURANCE
1 17 2011
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..;-:THI& CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT:'.If�the certificafe holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS.WAIVED, subject to
the terms and conditions of the poiicy,�certain policies may require an endorsement. A statement on this certificate -does not confer rights to the
certificate4 older>in lieu of such endorsement s
CONTACT-
_..:.;
� NAME:
lei Ha'rry.:A.' "'KOeh CO. ' PHONE FAX
'No. _
0 ;.. Bdk 45279 ....... _........_ .... E-MAIL _ C. -..
>aha NE 68145-0279 - -- -- ADDRESS:
INSURERS AFFORDING COVERAGE' NAIC #
INSURER A:FprlprAI Tncuranre Cmmnanv 0281
INSURED INSURER B
First National of Nebraska, Inc. INSURERC:
Attention: Patrick Mahoney INSURERD:
1620 Dodge St Stop Code 1155
Omaha NE 68197-1155 INSURERE:
INSURER F :
('nVFRAr:FC rFRTIFICOTF NIIMRFR- i of A - m,) • 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
LTR
TYPE OF INSURANCEADDLSUBRI
INSR
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DDIYYYY
LIMITS
A
GENERAL LIABILITY
35757477
1/18/2011
/18/2012
EACH OCCURRENCE
$1,000,000
X COMMERCIAL GENERAL LIABILITY
A A
PREMISES Ea occurrence
$1,000,000
MED EXP (Any one person)
$10, 00o '
CLAIMS -MADE KIOCCUR
PERSONAL & ADV INJURY
$1,000,000: ' -
'
GENERALAGGREGATE
$2, 000, 000
GEN'L`AGGREGATE LIMIT APPLIES PER:-`
PRODUCTS -COMP/OPAGG'
"$Included.. = '
{.t.: „
/'' `•'
POLICY PRO- LOC
JE
B-''AUTOMOBILELIABILITY'it,
t ".., -; t
'•
- ,, :
..,�
•-.
73560467
1/18/2011,...
%18/2012_."
...,.`
Ea accident
'...... •.......-._..-._,.,_.._ _.
1 000,000
'BODILY, INJURY (Per person),
.$ -.t,,
�i'
g°'' G d J '. ' r e - �.
ANY AUTO,
ALL OWNED'. ...._ .. SCHEDULED
AUTOS • .. . - AUTOS,:.
• -' ''•NON-0WNED
X' HIRED AUTOS X : AUTOS , •'
-
'
-
. •'
,.a' ^•+ ''.
-
t' .:. -- '„ _•
'.
•,.......
._ ...... „. '
:BODILY INJURY (Peracciden)
$-
"
PROPERTY DAMAGE
Per accident
$
UMBRELLA LIAB
HCLAIMS-MADE
OCCUR--
-
;EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
DED RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
N / A
71701763
1/18/2011
/18/2012
WC TH-
X ORYLI IT ER
E.L. EACH ACCIDENT
$500, 000
E.L. DISEASE - EA EMPLOYEE
$500, 000
E.L. DISEASE - POLICY LIMIT
1 $500, 000
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
The City of Ft. Collins, its officers, agents & employees are named as additional insured for
general liability but only insofar as loss or damage was the result of negligence of First
National Bank (Ft. Collins). First National Bank (Ft. Collins) is a named insured under the
policies.
/ MMM 101e'ATC Ue%l n1=0 rAmrFI I ATInKI
City of Ft . Collins; Director of
Y
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Purchasing & Risk Management
ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 580
Fort Collins CO 80522
_
AUTHORIZED REPRESENTATIVE
W 1tI50-LU1U AI.VKLJ t VKYVKA 1ICJIV. All rignI5 re5erVeU.
ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD