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Home My WebLink About563034 MEDORA CORPORATION - INSURANCE CERTIFICATE (4)-�1 MEDOCOR-01 PKU� ACORO CERTIFICATE OF LIABILITY INSURANCE DATE 0(MM/DDIYYYY) 1/03/2018 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 j 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 NAME: Phoebe Kuntz Choice Financial Insurance 323 18th St W (A/CC,NNo, Ext): (701) 483-1864 (n/c, No):(701) 483-1234 Dickinson, ND 58601 E-MAIL ADDRESS: p• � grou kuntZ choicefinancial com p' INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Scottsdale Insurance Company 41297 INSURED INSURER B : Midwest Family Mutual Insurance Company 23574 Medora Corporation INSURER c National Casualty Company 3225 HWY 22 N INSURER D : Dickinson, ND 58601 INSURER E INSURER F : 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 TYPE OF INSURANCE ADDL SUER LTR I POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR VRS0003117 01/01/2018 01/01/2019 DAMAGE TO RENTED PREMISES (Ea occurrence) 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 01/01/2018 01/01/2019 BODILY INJURY (Per person) $ OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ NON-OWNED DAMAGEXU PROPERTY accident) ridt $ATOS ONLY AUTON A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,0001 X EXCESS LIAB CLAIMS -MADE VES0002438 01/01/2018 01/01/2019 AGGREGATE $ 5,000,000 DED X RETENTION$ 0 $ C WORKERS COMPENSATION PER OTH- STATUTE ER AND EMPLOYERS' LIABILITY Y/N WCC332345A 01/01/2018 01/01/2019 1,000,000 ANY ECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A 1,000,000 (Mandatoryin 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 VRS0003117 01/01/2018 01/01/2019 Pollution 1,000,000 A General Liability VRS0003117 01/01/2018 01/01/2019 Professional 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Rerrarks Schedule, may be attached if more space is required) III i i, City of Fort Collins PO Box 580 Fort Collins, CO 80522 ELLATION 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 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD