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HomeMy WebLinkAboutFIRST NATIONAL OF NEBRASKA INC - INSURANCE CERTIFICATE (11)ACORN® `� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1/13l2017 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 endorsements . PRODUCER The Harry A. Koch Co. P.O. Box 45279 Omaha NE 68145-0279 CONTACT AME: FAx .402-861-7000 402-861-7111 E-MAIL INSURERS AFFORDING COVERAGE NAIC # INSURER A: Federal Insurance Company 20281 INSURED INSURERB:Great Northern Insurance Company 20303 INSURERC:Travelers First National of Nebraska, Inc. Attn: Risk & Insurance Dept 1620 Dodge St., Mail Stop 1151 INSURER D: INSURERE: Omaha NE 68197 INSURER F : CO'vFRAGFS CPRTIFICaTF !e!IIi!FtFFt• 391975424 DPVICI(Mt fitn1ARCD• 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 I TYPE OF INSURANCE ADDLSUBR IN D WVD POLICY NUMBER POLICY EFF MM/DD/YYYY) POLICY EXP (MMIDDfYYYYI LIMITS A GENERAL LIABILITY CLAIMS -MADE �X OCCUR 35757477 1/18/2017 1/18/2018 EACH OCCURRENCE $1000000 4COMMERCIAL DAMAGE TO RENTED PREMISES Ea occurrence) $1000000 MED EXP (Any one person) $10000 PERSONAL & ADV INJURY $1000000 GEN'L %( AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO - POLICY ❑ LOC OTHER: GENERAL AGGREGATE $2000000 PRODUCTS - COMP/OP AGG $Included $ B AUTOMOBILE X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 73560467 1/18/2017 1/18/2018 Ea accident $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY Per accident ( ) $ PR PERT A A E Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION$ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) f � os, dcscdbe under DESCRIPTION OF OPERATIONS below N / A UB8H919083 1/18/2017 1/18/2018 PER OTH- X STATUTE ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE - FOLIC'! 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. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ft. Collins; Director of Purchasing & Risk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Management ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 Fort Collins CO 80522 AUTHORED REPRESENTATIV ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD