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HomeMy WebLinkAboutFIRST NATIONAL OF NEBRASKA INC - INSURANCE CERTIFICATE (3)ACC)RLP CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDOIYYYV) 1/17/2012 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: R the certificate holder Is an ADDITIONAL INSURED, the policy(les) 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 The Harry A. Koch Co. P.O. Box 45279 Omaha NE 68145-0279 COWACT NAME: (HONE FAX Ent - ac No 402-861-7111 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC,i INSURER A:Fedefal Insurance Company 20251 INSURED First National of Nebraska, Inc. Attention: Patrick Mahoney 1620 Dodge St Stop Code 1 155 Omaha NE 68197-1155 INSURER a: INSURER C: _ INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 821414272 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 INSURANCE POLICY NUMBER MMIODIYYYV MMI001YYYY LIMITS A GENERAL LIABILITY % COMMERCIAL GENERAL LIABILITY CLAIMS MADE I ^ I OCCUR 5757477 1/18/2012 1/18/2013 EACH OCCURRENCE $1,000,000 PREMISES Ea Occuao nn $1,000000 MEDEXP(Any.na arson) $10,000 PERSONA- A ADV INJURY $1 000 000 GENERAL AGGREGATE $2,000000 GENL AGGREGATE POLICY LIMIT APPLIES PER: RO LOC F� PIFQT PRODUCTS - COMP/OP AGG $Included $ B AUTOMOBILE % % UABIUTY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON'OWNED HREDAUTOS P AUTOS 73560467 VIB/2012 V18/2013 OtAltimn 1,000000 BODILY IWURY(Par person) S GODLY INURY(Par a¢ideal) S PROPERTY DAMAGE Pet a¢'eenl S 4 UMBRELLA CAD EXCESS UAB OCCUR CIAMSSMADE EACH OCCURRENCE S AGGREGATE $ CED I RETENT"$ $ A WORKERS COMPENSATION AND EMPLOYERS' UABJUTY Y/N ANY PROPRIETORPARTNEREXECUTIVE OFHCERMEMBER EXCLUDED? (Mandatory In NH) Ill; iss uMat DRIPTM3NOFOPERATIONSlaelm N/A �1701763 1/18/2012 1/18/2013 X WC STATU OTH- E.L.EACHACCIDENT S500,000 E. L. DISEASE - EA EMPLOYEE 5500000 E. L. DISEASE -POLICY LIMIT S500.000 DESCRIPTION OF OPE RATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space Is required) RE: Banking Services Agreement. The City of Ft. Collins, its officers, agents and employees are named as additional insured for general liability and auto liability as required by written contract executed prior to a loss, but only insofar as loss or damage was the result of negligence of First National Bank, a division of First National Bank of Omaha. First National Bank, a division of First National Bank of Omaha is a named insured under the policies. City of Fort Collins Attn James B. O'Neill 215 N Mason Ft Collins CO 80524 SHOULD ANY OF THE ABOVE DESCRIBED POUCHES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 10AA.9nin Arn Rn rn RDnFATInN1 All .i,.M� —e.. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ,acoRoe CERTIFICATE OF LIABILITY INSURANCE DATE(MMMD/YYYY) 1/17/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I 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, INSUR_ER(S), AUTHORIZED - REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. --- - - " _ - ED, subject to - IMPORTANT: -.If the: certificate holder ls'an ADDITIONAL INSURED, the policyQes),must be endorsed; If SUBROGATION IS WAIVED, the terms and conditions of the olic , certain olicies ma require an endorsement: A statement on this certificatedoes-nottothe- certificate s holder in lieu of such endorsements . jPRODUCER CONTACT NAMEE .-.. ... "--, The ry A. Koch CO. P.O. B0 X45279 Omaha NE 68145-0279 PHONE , ,.: _,•:. -FAX'� . ESu-4 acNo: _ _ 7111 .MAIL - _. ADDRESS INSURERS AFFORDING COVERAGE NAIC0 INSURER A:Federal Insurance Company 20281 INSURED INSURERB.Great Northern Insurance INSURERC: First National of Nebraska, Inc. Attention: Patrick Mahoney 1620 Dodge St Stop Code 1155 . Omaha NE 68197-1155 INSURER D: INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 179R91R143 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 INSURANCE ADDL SUBR WVDPOLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY 35757477 1/18/2012 /18/2013 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED — PREMISES Ea xanence $1,000,000 MED EXP(Any one person) $10,000 CLAIMS -MADE OCCUR .PERSONAL& ADV INJURY $1,000,000 GENERALAGGREGATE S2,000,000'" .. U - � GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO Elnduded , ._._ ' �-' ""' � - - --� - ,"_.,.-., ,., $ POLICY, ..f., .PRO-u,' ", LOC '. ' �-' JECT ;B ., 4 .a"'...y -... B':. AUTOMOBILE LIABILITY ''" ;.l 73560467 ": ',:�,'1/16/2012- /1B/2013 Ea acdtlenf 1000000 BODILY INJURY (Per person) -''$ .-,._. __..... ,. ..X ANV AUT6 :. .a.iC .. , ..-. ';. .,'.'. ... .: .' "- .. .. ALL OWNED - `SCHEDULED' - AUTOS; AUTOS .' s "i?: - -�-- - "' "' :, BODILY INJURY (Per acddent) - - $. PROPERTY Per cc:.. ..... _ E .•'X HIREDAUTOS XAUTOS '• ., -. 4..-.�..,.. $ .. a UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ A WORKERS COMPENSATION 71701763 1/18/2012 /18/2013 X. WCSTATU- OTH- LIMITS AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNERIEXECUTIVE❑ E.L. EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? N/A EL DISEASE - EA EMPLOYEE $500,000 (Mandatory In NH) If yes, descnbs under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Add!Uonel Remarks S.M1 d.le, if more space is required) The City of Ft. Collins, its officers, agents & employees are named as additional insured for general liability as required by written contract but only insofar as loss or damage was the result of negligence of First National Bank, a division of First National Bank of Omaha. First National Bank, a division of First National Bank of Omaha is a named insured under the policies. CERTIFICATE HOLDER CANCELLATION City of Ft. Collins; Director of Purchasing & Risk Management PO Box 580 Fort Collins CO 80522 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 ©1988-2010 ACORD CORPORATION. All riahts reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD