No preview available
HomeMy WebLinkAboutFIRST NATIONAL BANK OF NEBRASKA INC - INSURANCE CERTIFICATE (3)P ATE (MM/DD/YYYY) '`�� R" CERTIFICATE OF LIABILITY INSURANCE 1 /17/2018 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 NAME:__ The Harry A. Koch Co. PHONE FAX P.O. Box 45279 (A/C, No, l: <1): 402-861-7000 AIc No : 402-861-7111 Omaha NE 68145-0279 ADDRESS: INSURER A: Federal Insurance Company 20281 INSURED INSURER B : Great Northern Insurance Company 20303 First National of Nebraska, Inc. Attn: Risk & Insurance Dept INSURER c: Travelers Indemnity Co. 25658 1620 Dodge St., Mail Stop 1151 INSURERD: Omaha NE 68197 INSURER E COVERAGES CERTIFICATE NUMBER 1773944R24 RFVISION Nl1MRFR- 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCEim POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y 35757477 1/1W018 1/18/2019 EACH OCCURRENCE $1000000 CLAIMS -MADE a OCCUR DAMAGE TO PREMISES Ea€occu-T ce $ 1000000 MED EXP (Any oneperson) $ 10000 PERSONAL &ADV INJURY $ 1000000 AGGREGATE LIMIT APPLIES PER : GENERAL AGGREGATE $2000000 GEN'L POLICY ❑ PRO- JECT ❑ LOC PRODUCTS -COMP/OP AGG $ Included $ OTHER: B AUTOMOBILE LIABILITY 73560467 1/18/2018 1/1872019 COMBINED SINGLE LIMIT Ea a.,d.r, $ 1 000 000_ _.. ._ BODILY INJURY (Per person) X ANY AUTO $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON-CWNED AUTOS ONLY AUTOS ONLY UMBRELLA LAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N UB31<852764 IMM018 1/18/2019 X PER OTH- STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE $ 500,000 (Mandatory in NH) If Yes, describe under DESCRIPTION OF OPERATIONS below - — - $ 500,000 E.L. DISEASE - POLICY LIMIT 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. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ft. Collins; Director of Purchasing & Risk ACCORDANCE WITH THE POLICY PROVISIONS. Management PO Box 580 AUTHO D REPRESENTATIV Fort Collins CO 80522 g��G.--- ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD