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Home My WebLink About563034 MEDORA CORPORATION - INSURANCE CERTIFICATE (2)MEDOR-1 OP ID: PK ,4CORO" CERTIFICATE OF LIABILITY INSURANCEATE `-� 12124/2 YYYY) 2/24/2015 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 Dacotah Insurance - Dickinson PO Box 1037 CONTANAME., Thomas Heisler AIC ONExt : 701-225-1200 FAC No : 701-483-0102 Dickinson, ND 58602-1037 Thomas Heisler E-MAIL Tom.heisfer@dactoahbank.com -ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Travelers Indemnity Company 25666 INSURED Medora Corporation, Medora Environmental Inc, Medora Tran INSURER B : -sport Corp, Gladdin LLC, PSI- INSURER C : INSURER D : ETS LLC, Solarbee Export Corp Joel Bleth 3225 HWY 22 N INSURER E INSURER F Dickinson ND 58601 COVERAGES CERTIFICATE NUMBER: 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 UB POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X X Y6600E550663TIA16 01/01/2016 01/01/2017 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,00 MED EXP (Any one person) $ 5,00 PERSONAL& ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X JEC LOC OTHER GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ 2,000,00 E&O $ 1,000,00 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS X X BAOE55066315CAG 01/01/2016 01/01/2017 COMBINED SINGLE LIMIT Ea accident $ 1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peraccident $ A X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE X X YSMCUPOE550663TIL16 01/01/2016 01/01/2017 EACH OCCURRENCE $ 8,000,00 AGGREGATE $ 8,000,00 DIED I I RETENTION $ 0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/Y❑N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes. describe under DESCRIPTION OF OPERATIONS below N/A X YHUBOE51928A16 01/01/2016 01/01/2017 X I PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E L DISEASE - POLICY LIMIT 1 $ 1,000,00 A • Foreign Gen. Liab Foreign Auto Liab ZPP15R9678316 ZPP15R967831f, 01/01/2016 01/01/2017 Liability 1,000,000 Liability 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Primary Additional Insured & 30 Day Cancellation Endorsements are added for the City of Fort Collins on the General, Auto Liability policies. I..CIC I Irrt�m I C r7ULUCK CITYFOR City of Fort Collins 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 81- @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD