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Home My WebLink About119633 MASEK DISTRIBUTING INC - INSURANCE CERTIFICATEMASEK-1 OP ID- NL A"11I CERTIFICATE OF LIABILITY INSURANCE DATE DYYYY) 10/31/11 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. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER - - 314 231 -1717 Richard Maxedon 314-231 4482 C.J. Thomas Company, Inc. 800 Market Street;18th Floor _ _ ... _ _ - — - - — St. Louis, MO 63101 CONTACT PHONE - FAx A/c No Ext : - - A/c No E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE ' - NAIC If Richard Maxedon _ INSURER A: National Fire 20478 INSURED Masek Distributing, Inc. New Ports, LLC 425 M St Building 1 Gering, NE 69341 INSURER B:Accident Fund Insurance Co: - 10166 INSURERC:Continental Insurance 35289 INSURERD:Continental Casualty Company 20443 INSURER E: INSURER F: 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 rypE OF INSURANCE ADDL UB POLICY NUMBER POLICY EFF MM/DD/YVYY1 POLICY EXP IMMIDDIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X CNP4012387759 11/09/11 11/09/12 ZENTED PREMISES AMA 1 occurrence $ 300,00 CLAIMS -MADE rx] OCCUR MED EXP (Any one person) $ 10,00 PERSONAL& AM INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 - GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 ------•- ----' X POLICY PRO1EC- LOC . "..__ ___.._-_ _ _.__.. _. - _ $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT - Ea accident '" - $ 1,000,00 C ANY AUTO X BUA4012387731 '11/09/'11 11/09/12 X BODILY INJURY(Pe person) $ ALLOWNED SCHEDULED - - AUTOS AUTOS BODILY INJURY (Per accident) . $ , HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $' - - X UMBRELLA LIAB I X OCCUR EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 D EXCESS LIAB CLAIMS -MADE B4012387762 11/09/11 11/09/12 DED I X RETENTION$ 10000 $ 1 WORKERS COMPENSATION WC�TATU- OTH- XER ANDEMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 500,00 B ANY PROPRIETOR/PARTNER/EXECUTIVEY/N OFFICERIMEMBER EXCLUDED? N/A WCV6050318 11/09/11 11/09/12 (Mandatory In If yes, describeaunder under E.L. DISEASE - EA EMPLOYEE $ 500� 00 E.L. DISEASE -POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS below D Equipment Floater C4013163258 11/09/11 11/09/12 Golf Cars 3,090,00 Ded 2,50 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Ft. Collins, its officers, agents and employees are included as additional insured in regards to the liability auto and general liability in regards to the contract with the named insured. CITYOFF City of Ft Collins Attn: Jim Hume P.O. Box 580 215 N. Mason St 2nd Floor Ft. Collins, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE v Tat$t$-Zulu ACURD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD