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Home My WebLink About563034 MEDORA CORPORATION - INSURANCE CERTIFICATE�-� MEDOCOR-01 PKUNTZ ACOR D DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE F12/26/2018 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 have ADDITIONAL INSURED provisions or 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 CONTACT Phoebe Kuntz Choice InsuranceFAX PHONE 323 18th St W (A/C, No, Ext): (701) 483-1864 (A/c, Nn):(701) 483-1234 Dickinson, ND 58601 ADDRESS: p•kuntz@bankwithchoice.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Scottsdale Indemnity Company 15580 INSURED INSURER B : Midwest Family Mutual Insurance Company 23574 Medora Corporation INSURER C: Scottsdale Insurance Company 41297 3225 HWY 22 N INSURER D: National Casualty Company 11911 Dickinson, ND 58601 INSURER E INSURER F : COVERAGES CFRTIFICATF NIIMRFR- 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 TYPE OF INSURANCE IN ADD SUBR POLICY NUMBER POLICY EFF POLICY EXP LTRIN M / LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR VRS0003660 1/1/2019 1/1/2020 AMAGETED PREMSESO(Eaolccurrence) $ 100,000 X ND STOP GAP MED EXP (Any one person) $ 10,000 1,000,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ X POLICY PRO LOC JECT PRODUCTS -COMP/OP AGG $ 2,000,000 ND STOP GAP 1,000,000 OTHER $ B COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO CPND0560117208 1/1/2019 1/1/2020 BODILY INJURY (Per person) $ OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident ( ) $ X HIRED NON -OWNED PerOPERTntDAMAGE $ AUTOS ONLY AUTOS ONLY C+ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 X EXCESSLIA13 CLAIMS -MADE VES0002659 1/1/2019 1/1/2020 AGGREGATE $ 5,000,000 DED X RETENTION $ 0 S D WORKERS COMPENSATION X PER OTH- STATUTE ER AND EMPLOYERS' LIABILITY YIN WCC332345A 1/1/2019 1/1/2020 1,000,000 ECUTIVE E.L. EACH ACCIDENT $ OFFIPER//MFMBeR EXCLUDED? N / A 1,Oi)0,Oo0 (Mandatory in NH) E L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT 1,000,000 $ A Pollution Liability VRS0003660 1/1/2019 1/1/2020 Pollution 1,000,000 A Professional Liab VRS0003660 1/1/2019 1/1/2020 Professional 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Renarks Schedule, may be attached if more space is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) U 1988-ZU15 AGUKU UUKVUKA I IUN. Au ngnis reserveu. The ACORD name and logo are registered marks of ACORD