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Published by Alpha Omicron Pi, 2018-02-26 11:32:49

10) Certificate of Insurance

ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
TM
12/27/2017

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 CONTACT
NAME:
Holmes Murphy 800.736.4327 FAX 800.328.0522
13810 FNB Parkway PHONE (A/C, No):
Suite 300 (A/C, No, Ext):
Omaha, NE 68154 E-MAIL
INSURED Alpha Omicron Pi Fraternity, Inc. ADDRESS:

DBA: Alpha Omicron Pi Foundation, Inc INSURER A : INSURER(S) AFFORDING COVERAGE NAIC #
5390 Virginia Way
Brentwood, TN 37027 Admiral Insurance Company 24856

INSURER B :

INSURER C :

INSURER D :

INSURER E :

COVERAGES INSURER F : REVISION NUMBER:

CERTIFICATE NUMBER: 18-19 All Rec

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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSR WVD (MM/DD/YYYY) (MM/DD/YYYY)
GENERAL LIABILITY CA000020565-04 01/01/2018 01/01/2019
A EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY $ 1,000,000
CLAIMS-MADE X OCCUR DAMAGE TO RENTED
PREMISES (Ea occurrence) Excluded
X Host Liquor 1,000,000
MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $ 2,000,000

GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000

POLICY PRO- LOC $
JECT $

AUTOMOBILE LIABILITY CA000020565-04 01/01/2018 01/01/2019 COMBINED SINGLE LIMIT 1,000,000
(Ea accident)

ANY AUTO BODILY INJURY (Per person) $

A ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS
AUTOS

X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $
AUTOS (Per accident)

$

UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $

DED RETENTION $ $
OTH-
WORKERS COMPENSATION WC STATU-
TORY LIMITS ER
AND EMPLOYERS' LIABILITY Y/N
E.L. EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTIVE N/A

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $

If yes, describe under E.L. DISEASE - POLICY LIMIT $

DESCRIPTION OF OPERATIONS below

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)

The certificate holder is an insured in regards to the above policy.

CERTIFICATE HOLDER CANCELLATION

All recognized undergraduate chapters, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
colonies, house corporations, foundations, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
alumnae chapters or associations and parents ACCORDANCE WITH THE POLICY PROVISIONS.
clubs of Alpha Omicron Pi
Fraternity Inc. AUTHORIZED REPRESENTATIVE

Edward (Ned) Kirklin/KARI

© 1988-2010 ACORD CORPORATION. All rights reserved.

ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD


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