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HomeMy WebLinkAboutFIRST NATIONAL OF NEBRASKA INC - INSURANCE CERTIFICATE (9)DATE CERTIFICATE OF LIABILITY INSURANCE (MM/DD/YYYY) 1 /15/2016 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 The Harry A. Koch Co. PHONE 402-861-7000 FAx 402-861-7114 P.O. Box 45279 E-MAIL Omaha NE 68145-0279 INSURER A: Federal Insurance Compc INSURED INSURER B :Great Northern Insurance First National of Nebraska, Inc. INSURER C : Attn: Risk & Insurance Dept 1620 Dodge St., Mail Stop 1151 INSURERD: Omaha NE 68197 INSURERE: COVERAGES CERTIFICATE NUMBER: 1234846079 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE B POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY 35757477 1/18/2016 1/18/2017 EACH OCCURRENCE $1000000 CLAIMS -MADE x] OCCUR DAMAGEISESSRENTED PREMoccurrence)$1000000 MED EXP (Any one person) $10000 PERSONAL & ADV INJURY $1000000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2000000 XPOLICY n PRO- JECT D LOC PRODUCTS - COMP/OP AGG $IrlCluded $ 1 I OTHER: I B AUTOMOBILE LIABILITY 73560467 1/18/2016 1/18/2017 COMBINED SINGLE LIMIT$ Ea accident 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO _ ALL AUTOS SCHEDAUTOS BODILY BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N 71701763 1/18/2016 1/18/2017 X PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? N /A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $500,000 If yes. describe under DESCRIPTION OF OPERATIONS below _ - — E L. DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 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. L;tK I IFIUA I t HULUtK UANL;tLL.A I IUN 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 �eT% © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD