HomeMy WebLinkAbout98- Gallatin County Fire Protection
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GALLATIN COUNTY FIRE PROTECTION MUTUAL AID AGREEMENT - 1997
THIS AGREEMENT will take effect between and among the signing
agencies when two or more local governments, fire districts or fire
service areas in Gallatin, Madison, Park, Broadwater, Beaverhead,
or Jefferson Counties sign the Agreement. This Agreement will
supersede all prior Gallatin County fire protection mutual aid
agreements signed by the signatories of this Agreement.
WIT N E SSE T H
WHEREAS I the signatory agencies desire to augment fire
protection in their areas pursuant to sections 7-]]-2108, 7-]]-
2202, 7-]]-2405 and 7-]]-4112, MCA; and
WHEREAS, it is beneficial for the signatory agencies to render
mutual aid in accordance with the terms of this Agreement.
NOW, THEREFORE IT IS UNDERSTOOD AND AGREED AS FOLLOWS:
1- DEFINITIONS.
A. "Agency" means any signatory local government unit, fire
district, fire service area, and where appropriate their respective
fire departments, including but not limited to:
Amsterdam Rural Fire District
Beaverhead County Rural Fire District # 2
Belgrade Cjty Fire Department
Belgrade Rural Fire District
Bozeman City Fire Department
Bridger Canyon Rural Fire District
Broadwater county Rural Fire District
Clarkston Fire Service Area
Clyde Park Town Fire Department
Clyde Park Rural Fire District
Dillon City Fire Department
Fort Ellis Fire Service Area
Gallatin Canyon Consolidated Rural Fire District
Gallatin Gateway Rural Fire District
Gallatin County
Gateway Hose Company #1 Rural Fire District (Gardiner)
Jefferson Valley Rural Fire District
Livingston city Fire Department
Madison Valley Rural Fire District
Manhattan city Fire Department
Manhattan Rural Fire District
Park County Rural Fire District No. 1
Paradise Valley Fire Service Area
Rae Fire Service Area
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Reese Creek Fire Service Area
Sedan Rural Fire District
sourdough Rural Fire District
Springhill Fire Service Area
Three Forks City Fire Department
Three Forks Rural Fire District
Townsend city Fire Department
West Yellowstone City Fire Department
Whitehall city Fire Department
Willow Creek Fire District
Wilsall Rural Fire District
B. "Requesting Agency" means the agency asking assistance,
C. "Responding Agency" means the agency sending assistance,
2. TERM.
A. This agreement shall be in effect until June 30, 2000,
and shall automatically renew for additional three (3) year
periods, unless amended or terminated. Any agency may request
a review of the agreement six (6) months prior to an automatic
renewal date by sending proposed amendments to all other
agencies.
B. Any agency may withdraw from the agreement by giving at
least sixty (60) days written notice to all other agencies.
3. OPERATIONS.
A. Reauest and Response.
1. The fire chief or designee or incident commander
from any agency may request assistance from any other
agency or agencies only when it is determined that such
assistance is essential to protect life or property.
2. A request for assistance should include the type of
incident or emergency and the type of equipment, the
number of personnel and specify the location where
needed. Giving assistance is not mandatory. However, if
an agency cannot give assistance it shall immediately
inform the requesting agency that assistance cannot be
given.
3. A responding agency shall immediately determine what
equipment or personnel or both can be spared and then
dispatch the designated equipment and personnel and
inform the requesting agency.
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B. Command at Incident Scene.
1. Personnel from the responding agency shall report to
the requesting agency's fire chief, designee, or incident
commander. The responding agency's equipment and
personnel shall be under the immediate supervision and
responsibility of the requesting fire chief or designee
or incident commander during the actual operation.
2. The requesting fire chief or designee or incident
commander may request an officer of a responding agency
to assume command. However, relinquishing command shall
not relieve the requesting agency of responsibility for
the operation.
3. All operations will be under an incident management
system as authorized by Section 8 of this Agreement.
C. Release from Incident.
A requesting agency shall release a responding agency when
services are no longer required or when the responding agency
is needed for service in its own area or when the responding
agency requests release.
4. REIMBURSEMENT.
A. Fuel and Reasonable Welfare Items.
A requesting agency shall provide fuel and reasonable welfare
items for responding agencies. However, responding agencies
may elect not to be reimbursed.
5. RESPONSIBILITY AND LIABILITY.
A. Preparedness and Safety.
1. Each agency shall be responsible to see that its own
equipment is properly maintained and safely operated
and its personnel properly trained.
2. A responding agency will not be required to take
action where the safety of personnel and equipment is in
question.
3. Personnel of a responding agency shall be considered
to be acting under the lawful orders and instructions of
their own agency to and from the operation. They are not
to be considered personnel or employees of any other
agency.
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B. Insurance and Damaqes.
1. Each agency shall obtain appropriate insurance for
its equipment and personnel. Each agency shall obtain
liability insurance in the amount of $1,000,000. Each
agency shall provide written proof of such insurance at
the time the agency signs the agreement. Such proof of
insurance shall be kept in the office of Gallatin
county's Fiscal Officer and the Gallatin County Clerk &
Recorder. Each agency must ensure that such liability
insurance remains in effect at all times the agency is a
party to this Agreement. It shall be the responsibility
of each agency to provide updates of written proof of
such insurance, when issued, to the Offices of the Fiscal
Officer and the clerk and Recorder,
2. Each agency shall be responsible for defending
claims made against it or its personnel arising from
participation in this agreement. Agencies shall not be
obligated to defend claims made against another agency or
its personnel.
6. INSURANCE BENEFITS.
A. Gallatin county agrees to provide insurance for duly
enrolled Gallatin County agency volunteer firefighters in at
least the following amounts when the person is actively
engaged in incident response or during transportation to or
from an incident under this Agreement:
1. Accidental death or dismemberment - $25,000
2. Accidental medical expense - $10,000
3. Heart attack death benefit - $25,000
B. This coverage will be furnished only for agencies which
provide some disability insurance of their own for volunteer
firefighters. Membership in the Montana Volunteer
Firefighters' Compensation Act is acceptable for this purpose.
7. MONTANA FIRE CODES.
Applicable Montana Fire Codes apply to this agreement.
Agencies not having NSHT 1 1/2" and 2 1/2" hose shall provide
adapters to facilitate the use of hose and pumps on incoming
equipment.
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8. ADDITIONAL OPERATING PROCEDURES.
Agency fire chiefs are authorized to meet and draft procedures
to implement this agreement. Such procedures shall become
effective upon ratification by the Gallatin county agency fire
chiefs.
9. ADMINISTRATION. SEPARATE LEGAL ENTITY AND PROPERTY.
A. No administrator or joint board is required to effect the
purposes of this agreement.
B. No separate legal entity is created as a result of this
agreement.
C. The ownership of property by each agency shall not be
affected as a result of this agreement. Property acquired
during the term of this agreement shall belong to the agency
acquiring the property.
10. FILING OF AGREEMENT.
The original of this Agreement shall be filed with, and copies
may be obtained from, the Gallatin County Clerk and Recorder.
II. EFFECTIVE DATE OF AGREEMENT
This Agreement shall be in effect when two (2) or more
agencies sign.
IN WITNESS WHEREOF, the undersigned, who are trustees or
designated persons, have executed this Agreement on behalf of their
Fire Department, Fire District, Fire Service Area, or local
government entity, as of the day and year by their names,
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GALLATIN COUNTY FIRE PROTECTION MUTUAL AID AGREEMENT
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GALLATIN COUNTY FIRE PROTECTION MUTUAL AID AGREEMENT
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GALLATIN COUNTY FIRE PROTECTION MUTUAL AID AGREEMENT
SIGNATURE PAGE
Organization
Title Signature Date
organization
Title signature Date
organization
Title Signature Date
Organization
Title Signature Date
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Title Signature Date
."~-~ EMC lJ1.surance .companies
"'PLOYERS M AL CASUALTy l..{)MP~NY PRIOR JLICY: 006-60-38
----
G ENE R A L L I A B I LIT Y D E C L A RAT ION S
lICY PERIOD: * ---------,------------ ---*
FROM 07/01/97 TO 07/01/98 * POLICY NUMBER *
* 0 0 6 - 6 0 - 3 8---98 *
*------------------------*
N A M E D INS U RED: PRO D U C E R:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - _. - - - - - - -
AMSTERDAM RURAL FIRE WESTERN STATES INS. AGENCY, INC
DISTRICT
% DENNIS BOEHLER, TREASURER 2925 PALMER STREET SUITE B
6075 MONARCH DR. PO BOX 4386
MISSOULA, MT.
j MANHATTAN, MT. 598064386
1 59741 AGENT NO: AP-7430-4
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AGENCY BILL
- - - - -" - - - - - - - - - - - - - - - - - _. - - - - - - - - - - - - - - -
NSURED IS: FIRE DISTRICT BUSINESS DESC: FIRE DISTRICT
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
I,IMITS OF INSURANCE
GENERAL AGGREGATE LIMIT (OTHER THAN PRODUCTS / COMPL OPS) $ 1,000,000
PRODUCTS/COMPLETED OPERATIONS AGGREGATE LIMIT $ 1,000,000
PERSONAL AND/OR ADVERTISING INJURY LIMIT $ 500,000
EACH OCCURRENCE LIMIT $ 500,000
FIRE DAMAGE LIMIT (ANY ONE FIRE) $ 100,000
MEDICAL EXPENSE LIMIT (ANY ONE PERSON) $ 5,000
~------ ----,---- ----,------- ------------- --,--,---,-------------- ---- --,----.- - -- -- -- ---
.
C 0 V ERA G E S PRO V IDE 0 PRE M I U M
- -...... -- - - - - .......- -....... --~ - --.- -- -- -----.- - ,_.- - ------ -_._---------~---
OTHER THAN PRODUCTS/COMPLETED OPERATIONS $ 536.00
......-..- -.-----------------.---- .-.-- ~ ._._._-~---_........~~-- - -.-.- ._--- ------.
TOTAL ESTIMATED POLICY PREMIUM $ 536.00
--------~,-----,--_._~._-~_._,----_._--~-'-_.__._~--~-------
--------------_._-------------------------'--_._~-------------------~~--_._._------
SEE ATTACHED SCHEDULE FOR LOCATION
OF ALL PREMISES OWNED, RENTED OR OCCUPIED. -
._---------._-~_.......-_.- --- -----.-....-------.----.-...- _._- ---.- ---- ~ .-.--------.--- -- - .--.- ---.--.-.- .......... ~.._.-- ~------ ----
:ORMS APPLICABLE: (; ". ,. ~"-@-f-ril{~
CG7001A (01-86) CG7003(03-96) CGOO01(01-96)
CG2147(10-93) CG2150(09-89) CG2256(01-96) 11 ---,
CG2021(01-96) CG7128(08-88) CG7129(08-88)
. ,,..,-.,
CG7127(03-96) IL0021(11-94) IL0243(06-89) , Iv '-~ - ~ I()?'~
"'" IL7039(11-93) IL0167(07-92) CG8057(01-96)
fill; CG0054(03-97) CG0055(03-97) ~rl'<nl..""'..........,,..-c~_.T>"O'..,,...................,
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I)ATE OF ISSUE: 07/09/97 BPP /
~ORM CGIOOOA ED.01 86 0'J/1t;/9( OO~ LM 0066038 9801
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GALLATIN COUNTY FIRE PROTECTION MUTUAL AID AGREEMENT
SIGNATURE PAGE
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Title / IDette
organization
Title Signature Date
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Title Signature Date
Organization
Title Signature Date
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Title Signature Date
03/15/1'3'38 l '
10: 38 . 14855f~5~1'J:':i WESTERN STATES INSI . i
PAGEl Ell
ACORD CERTIFICATEuF LIABIL..1TY INSURA~~L5 U"'''l"'''''uu""
.~~._._- .... .."*'.. . "LA!? 0 3 / 16/ 90
PRODUCER Tl-lIS CERTIFiCATE IS I'SSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Western States In. - Bo:zaman HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
POBox 430 ALTER THE COVERAGE AFFORDED BY THE poLICIES BELOW.
Bozeman MT 59771 COMPANIES AFFORDING COVERAGE
I .-..---"-'
Timothy P Fitzg..rald III i COM;ANY Employera MUtual/Vol Firl!l
Phon. ~o:_~ 6 - ?!l6 - 3 3 51 F". ~o. 406 -58 6 -0 43 7 I --
INSUREO . ~l COM~ANY
i'ire Dill (r!;~ '- I COMPANY .'--
Ga~~atin Canyon Rural
C/O Bob StobRX' ~\V\< . C
PO Box 160382 ~e.. IX\: I COMPANY ~._~~,'- --,. .--"-'"
Big Sky MT 59716 .\ D
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COVERAGES
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, fHE INSURANCE AFFORDED BY THE POLICIES DESCRIElEP HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLlCl1,S_ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CUlIMS.
..~.. _._.~ : I I .."~_.. ._~.
co i TYPE OF INSUR.ANCI'! i POLICY NUMeEIl .. POLICY IOI'FECT'VE iPtlLICY IiXPI~ATION i LIMITS
LTR. i DATE: (MMIDDIYY) , DATE (MIoIIODIYY) I
I
i~E"AL UABILlTY OD97.\9798 i 07/01/'37 I '1 GENE'RAL AGGREGAT~..~_~OOO 000
A .. X I COMMERCI"L~ENEl:tA, LIASILlT'( 07/01/ 96 i PRODUCTS" COMP/O? 'lOG I $ , 2 0 O~.
r I .I CLAIM5 MADE L!J OCCUR i I PERSONAL&AOVINJURT I ~ 1000000
, OWNER'S'" CONTRACTOR'S PROT I EACH OCCURRENCE I $ 1000000
Ii,] LINEB1I.c=.P:R_ - i I FIRE D"'M~GE (Any on~ ~ ; 100000
I rMED EXP (,o,ny OM p~'~~nl S "'.-
I I I 5000
I AUTOMOBILE LIABILITY I I
A \Xl ANY AUTO I COMBINED SINGLE LIMIT i $ 1000000
0&9749798 I 07/01/97 I 07/01/9B _----j~~--.
F .Cc ow"," .,,~ I I BODILY INJU RY '$
_ 1 SCHEOUU5:0 AUTOS (>"or p"<3MI I
I
J "",0.=, I BOOIL Y INJURY -'-1--'-- --
f=-, ':'""'~"^"'"' I (PilU QCC:ld,,"t) Is
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r PRC>"i:::R.TY DAMAGE o.
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~AGE LIABILITY "UTO ONLY - EA ACC:DENT ,0; .-. ,--'
.. i ANY AUTO I I OTf-li:::~ THAN AuTO CNL Y:
11 .~-----.-"-"""--"-'-
: EACH /lCDIDENT S
L-I._____. .-
I AGGREGATE : S
I Exel!SS liABILITY , EACH OCCURRENCE + 1000000
A [Xl UMBRELLA FORM OJ97497g9 07/01/97 07/01/9B I AGGREGATE _L.- 1000000
, OTHrn THAN UMBRELLA FORM ~
WORKERS COMP~NSATION AND I
E"'PLOYERS' LIABiliTY I
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'Hi::: PRCPIlIETORJ C=:' INCI_ I
PARTNER.!iJEXECUTIVF.
OF~tCERS AR.E: EXU.
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DESCRIPflON OF OPERAnONSllOCATlON~NEHICl&:W~per:IAI.ITEM~
FIRE DEPARTMENTS - VOLUNTEltR
-
CERT1FICA 1E HOLDER CANCELLATION
------1 SHOULD A~Y OF THe AIIOVE DESC"leED POllolES BE CANcelLED BEFOR.E THE
Gallatin County EXPIRATION DATE THell:eOF. Hi!;; IlSSUING COMPANY WILL ENDEAVOR TO r.'IAll
(J'AX 592-2158) --.1L DAY"" WRoTT!!N NOTICE TO THI! CEIlTIFIC"TE fiOLDER NAM1'.O TO THE LEn.
Gary Higginll BUT ,AlLURE TO MAIL ~UCI1 NOTICE SHALL IMPOSE NO OElllGATIDN OR LIABILITY
615 S. 16th Ave 0 , Room 202
BoZeman MT 59715 of ANY KIND upON THli COMPANY, iTS AGENTS OR REPRESENTATlVES_
ACORD 26:.8 (1/915) ~~(1~f~~ @ACORDCORPCRAll0N 1988
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GALLATIN COUNTY FIRE PROTECTION MUTUAL AID AGREEMENT
SIGNATURE PAGE
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Ml Cornmi5sioll Expires :vlay 6, 199. 9
Organization! ;(Jh<~~ )lc~
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itle Date
Organization
Title Signature Date
Organization
Title signature Date
Organization
Title Signature Date
organization
Title Signature Date
I .'_ tlYlL illSllrance ,Com,panies
/ EMPLOYERS MUTUAL CASUALTY COMPA, PRIOR P,- _ICY: "102-52-53 "J '"
~ " .. -
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G ENE R ALL I A B, I L. I ,T Y 0 E C L A RAT} 0 N S .'. ....
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c;;;;,;;. .-.-. -.-- --. -- ~ ._.. ..- -._, -." . ... ... " .. -... "u - .. ". .-...... ---.... ..__h _.... ..,' ..... c' *____________.____________* ".
'fOLTCY PERIOD: FROM 03/10/97 TO 03/10/98' ':':;'*f'-:-'":" POLICY NUMBER "i'::~;-.' *
\;:. ,.,,,'- , - . ... , . v '* 1 0'2 -'S~2 ..;. 5"3-;':~98 .*,~
.. - ---. . ...- - . *---------.----------.-----*
. ~;~.N A:M E 0 INS U RED: PRO D U C E R:
. . ...' '." .J1 .'~"" :;.': 'i; ... .
- ~ - - -, ......... - -- - .......- - - -. ~ -- -, - ....... - ~- - ~ ....... - ~ - - --. ~ - - -:-- - _. _. - ...... ...... ...... _.-':;
PARK'COUNTY RURAL FTRE~. WESTERN STATES INS. AGENCY, INC
DISTRICT 1
140 EAST MAIN
PO BOX 1134 PO BOX 430
BOZEMAN, MT.
LIVINGSTON, MT. 597710430
59047 AGENT NO: AP-7350-4
AGENCY BILL
- - - - - - ~ - - - - - - - - - - - - - -. - - - - - - - - - - - -- - - - - -
INSURED IS: FIRE DIST BUSINESS OESC: FIRE OIST
- - - - - - - - - - - - - - - - - - - -- - - -' _. - ~ -' - ~ - - -- -. - - -- -
L Hn T S 0 FIN S lJ RAN C E
GENERAL AG~REGATE LIMIT (OTHER THAN PROD~CTS ! CCMPL OPS) $ 2,000,000
PfWC'UCTS/CrJMPLETEO OPERATIONS AGGREGATE LIMIT $ 2,000,000
PERSONAL AND/OR ADVERTISING INJURY LIMIT $ 1,000,000
EACH OCCURRENCE LIMIT, $ 1,000,000
FIRE DAMAGE LIMIT (ANY ONE FIRE) $ 100,000
MEDICAL EXPENSE LIMIT (ANY ONE PERSON) $ 5,000
.,
- -~- -- -- ~._.- ~- ~......... -- -- - -'~ ~ - ~ ~~ &~~ -~_. ~ -- ~~- ~ -'- --- ___ ~.~_ _ _~ _w~ ~__~_ ~_~ __~~ ~ __~~ _~'~.~ _._ ~ __
C 0 V ERA G ESP R 0 V IDE D PRE M I U M
-------~--------------------~----- ---------.--.---
OTHER THAN PRODUCTS/COMPLEfED OPERATIONS $ 571.00
- -- ~ ...........-- ._,~_.~ - ~,- ~---~ -- ._~ '~.- ~'-_.- ~-- - -_.~ -~---'~ ~ --~ - - '~.- - ~ --
TOTAL ESTIMATED POLICY PREMIUM $ 571.00
- -- - -~ -~- ~~-- -'- _.~- --- - - ~--~- - ---~ -~- -~~ --- ~- -~.- - ~~ -- - ----
~ - - ~ ~- ~~ ~ -~- ~~ - - ~ ~- - - -~ -- -~-~--_.-......._~ - - -~-~ -,- ~ -~- -.- ~ ~~- -~-,--- ~,~................ ~ ~-- ~~'-- - ~ - ~ - --
SEE ATTACHED SCHEDULE FOR LOCATION
OF ALL PREMISES OWNED~ RENTED OR OCCUPIED_
~ - ~ - - - - ~ - --~.......... - ~'- -~~ ~ - -- -- ~ - -~ -,--........~~._.- --......... ~'_.- ~- -'- - -- - ~,~~~ -- - ~~,--~,- - ~ ~~_.~.- - ~ ~ ~ -- --
FORMS APPLICABLE:
CG7001A(01-86) CG7003(03-96) CG0001(01-96)
CG2147 (10-93) CG2150(09-89) CG8057(01-96)
CG2256 (01-96) CGZ021(01-96) CG7128(08-88)
CG7129 (08-88) IL0021(11-94) IL0243(06-89) i
!.J IL0167 <07-92) IL7039(11-93) CG7110(01~86) i
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~OATE OF ISSUE: 03/05/97 BPP ~
I FORM CG7000A EO.01-86 02/10/97 002 SL 1025253 9801
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GALLATIN COUNTY FIRE PROTECTION MUTUAL AID AGREEMENT
SIGNATURE PAGE
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Title signature Date
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Title signature Date
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-- GALLATIN COUNTY FIRE PROTECTION MUTUAL AID AGREEMENT
SIGNATURE PAGE
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BUSINESS o TRUCK INSURANCE EXCHANGE ~ 1f1ID-CENTURY INSURANCE COMPANY IX] FARM...oJ INSURANCE EXCHAfJGE
AUTO D
QfCLARATIONS
LXJ POLICY MEMBERS OF FARMERS INSURANCE GROUP OF COMPANIES
D COVERAGE PART HOME OFFICE: 4680 WILSHIRE BLVD" LOS ANGELES, CALIFORNIA 90010 R
ITEM ONE
NAMED THREE FORKS RURAL FIRE DIST
INSURED ATTN: GENE TOWNSEND Prematic Acc't No. Prod. Count
MAILING PO BOX 1 7n-11-l:i41 nn~Rn-4n-56
ADDRESS Agent Policy Number
THREE FORKS MT 59752
D Partnership Type of
The named insured is an individual D Corp. Business VOL FIRE DEPT
unless otherwise stated: D Joint Venture o Organization (other than Partnership or joint venture)
Policy Period from 03/10/97 (not prior to time applied for) to 03/10/98 12:01 AM Standard Time
If this policy replaces other coverages that end at noon standard time on the same day this policy begins, this policy will not take effect until the othel
coveraQe ends. This policy will continue for successive polic~ periods as follows: If we elect to continue this insurance, we will renew this policy if you pal
the reqUired renewal premium for each successive policy period su ject to our premiums, rules and forms then in effect .
ITEM TWO SCHEDULE OF COVERAGES AND COVERED AUTOS
"This polic;{ yrovides only those coverages where a cha~e is shown in ~he premium column below. Each of these coverages will apply only to those "autos" showr
as covere autos"." Autos" are shown as covered "au os" for a particular coverage by the entry of one or more of the symbols from the COVERED AUTO Sectior
of the Business Auto Coverage Form next to the name of the coverage.
* COVERED AUTOS LIMIT
THE MOST WE WILL PAY FOR PREMIUM
COVERAGES ANY ONE ACCIDENT OR LOSS
(LIMITS SHOWN IN THOUSANDS)
LIABILITY 7 $ 1000 1,414.00
PERSONAL INJURY PROTECTION SEPARATEL Y STATED IN EACH PIP ENDORSEMENT
(or equivalent No.Fault Coveraae)
ADDED PERSONAL INJURY PROTECTION SEPARATELY STATED IN EACH ADDEO PIP ENDORSEMENT
(or equivalent added no.fault cov.)
PROPERTY PROTECTION INSURANCE SEPARATELY STATED IN THE P,P.!. ENDORSEMENT MINUS
(Michioan onlv) $ DEDUCTIBLE FOR EACH ACCIDENT
AUTO MEDICAL PAYMENTS $ SEE SCHEDULE
UNINSURED MOTORIST 7 $ 1000 90.00
UNINSURED MOTORIST $
PROPERTY DAMAGE
UNDERINSURED MOTORISTS (When not $
incl. in Uninsured Motorists Coveraae)
PHYSICAL DAMAGE Actual Cash Value or Cost of Repair, whichever is
COMPREHENSIVE COVERAGE less minus $ SEE SCHEDULE Oed. for Each Covered
Auto. But no Deductible AfcPlies to Loss Caused by Fire or
Liohtnina. See Item Four or hired or borrowed "autos",
PHYSICAL DAMAGE SPECIFIED Actual Cash Value or Cost of Repair, whichever is
CAUSES OF LOSS COVERAGE 7 Less Minus $25 Oed. for Each Covered Auto for loss 63.00
Caused by Mischief or Vandalism. See Item Four for hired
or borrowed" Autos",
PHYSICAL DAMAGE Actual Cash Value or Cost of Retair whichever is
COLLISION COVERAGE 7 less minus $ SEE SCHEDUL Oed. for Each Covered 353.00
Auto, See item four for hired or borrowed" Autos",
PHYSICAL DAMAGE
TOWING AND LABOR $ for each disablement of a private passenger
"auto" (ACTUAL LIMIT)
I PREMIUM FOR ENDORSEMENTS
I ESTIMATED TOTAL PREMIUM 1,920.00
~
56.5190 3RD EDITION 12-91 - E.92 PAGE 1 OF 3
l .' -. .......-.. .... --- _.... _ J' ~~._..~_. _.,_,. - -
.-. , ,
06~ J-46-56 _...~
POLICY NUMBER
BUSINESS AUTO DECLARATIONS (Continued)
ITEM THREE
SCHEDULE OF COVERED AUTOS yOU OWN
DESCRIPTION TERRITORY
PURCHASED
Year, Model. Trade Name, Body Type Town & State where Covered
Serial Number (S) Vehicle Identification Number Original Actual Cost & Auto will be principally garaged
Covered (VIN) Cost New New (N)
Auto No. USED'(U)
1 68 IlIlnr~F TRTH'1/ 1 TON 40000 t:UHK~ MT 5
242
2 61 CHEVROLET TRUCK 2 TON 20000 THREE FORKS MT 5
730 5 TON 13000 THREE FORKS
3 70 DODGE MT 5
N81HPOT13062 THREE FORKS
4 63 DODGE PICKUP 6000 MT 5
06394 SUBURBAN 5000 THREE FORKS
5 73 CHEVROLET MT 5
GKU166F159270
CLASSIFICATION
Radius of Business use Size GVW, Age Primary Secondary Code Except for towing, all physical damage
Operation s - service GCW or Veh. Group Rating Rating loss IS payable to you and the loss
r - retail Seating Factor Factor payee named below as interests
Covered c - commercial Capacity Liab. Phy. may appear at the time of the loss.
Auto No. Dam.
1 ~ oHo~
2
3 '6 07909
4 6 07909
5 6 07909
COVERAGES-PREMIUMS. LIMITS AND DEDUCTIBLES(Absence of a deductible or limit entry in any column below means that the limit
or deductible entry in the correspondinq ITEM TWO column applies instead)
LIABILITY PERSONAL INJURY PROTECTION ADDED P.I.P. PROP. PROT. Mich. only)
*Limit Premium Limit stated in each Premium Limit stated in each Limit stated in P.P.!. Premium
Covered P.l.P. End minus de- Added P.l.P. End. end. minus deduct.
Auto No. ductible shown below Premium shown below
i ~888 ~~6.0
6.0
3 1000 308.0
4 1000 277.0
5 1000 277.0
Total 1,414.0C
Premium
COVERAGES-PREMIUMS, LIMITS AND DEDUCTIBLES(Absence of a deducti~)e or limit entry in any column below means that the limit
or deductible entry in the correspondinq ITEM TWO column applies instead
Covered AUTO MED. PAY UNINSURED MOTORISTS UNINSURED MOTORIST UNDERINSURED MOTORISTS
PROPERTY DAMAGE
Auto No. *Limit Premium *Limit Premium *Limit Premium *Limit Premium
i I ~ 8g8 HI. 00
18.00
3 1000 18.00
4 1000 18.00
5 1000 18.00
Total
Premium 90.00
COVERAGES-PREMIUMS. LIMITS AND DEDUCTIBLES(Absence of a deducti~l)e or limit entry in any column below means that the limit
or deductible entry in the correspondina ITEM TWO column applies instead
COMPREHENSIVE SPECIFIED CAUSES OF lOSS COLLISION TOWING LABOR
Limit stated in ITEM Premium Limit stated in ITEM Limit stated in ITEM Premium Limit Per Premium
Covered TWO minus deduc- TWO TWO minus deduct. Disablement
Auto No. iible shown below Premium shown below
'i ib:g8 -sQQ 1~~:88
500
3 8.00 500 63.00
4 4.00 500 25.00
5 4.00 500 25.00
Total
Premium 63.00 353.00
*(LJMiTS SHOWN IN THOUSANDS)
~5'!lO 3RD EDITION 12.9' - E-92 PAGE 2 OF 3
" .
, I
06 -46-56
BUSINESS AUTO DECLARATIONS (CONTINUED) Policy Number
ITEM FOUR
SCHEDULE OF HI:tED OR BORROWED COVERED AUTO COVERAGE AND PREMIUMS
LIABILITY COVERAGE RATING BASIS COST OF HIRE
STATE ESTIMATED COST OF HIRE RATE PER EACH $100 FACTOR~lf liab. PREMIUM
FOR EACH STATE COST OF HIRE COV. IS RIMARY
PREMIUM
Cost of hire means the total amount you incur for the hire of "autos" you don't own(not including "autos" you borrow or rent from your employees or their family
members). Cost of hire does not include charges for services performed by motor carriers of property or passengers.
PHYSICAL DAMAGE'COVERAGE
LIMIT OF INSURANCE ESTIMATED RATES PER PREMIUM
COVERAGES THE MOST WE WILL PAY ANNUAL EACH $100
DEDUCTIBLE COST OF HIRE COST OF HIRE
ACTUAL CASH VALUE. COST OF REPAIRS OR
$ WHICHEVER IS LESS MINUS
COMPREHENSIVE $ OED. FOR EACH COVERED AUTO.
BUT NO DEDUCTIBLE APPLIES TO LOSS CAUSED BY
FIRE OR LIGHTNING.
ACTUAL CAS VALUE, COST OF REPAIRS OR
SPECIFIED $ WHICHEVER IS LESS MINUS
CAUSES OF LOSS $25 OED. FOR EACH COVERED AUTO FOR LOSS CAUSED
BY MISCHIEF OR VANDALISM.
ACTUAL CASH VALUE. COST OF REPAIRS OR
COLLISION $ WHICHEVER IS LESS MINUS
$ OED. FOR EACH COVERED AUTO
PREMIUM
ITEM FIVE
SCHEDULE FOR NON-OWNERSHIP LIABILITY
NAMED INSURED'S BUSINESS RATING BASIS NUMBER PREMIUM
other than a Number of Em loyees $
Social Service Aaenc Number of Partners $
Social Service Agency Number of Em 10 ees $
Number of Volunteers $
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE
THE INSURANCE AS STATED IN THIS POLICY.
Premium shown is payable:$ 1,920.00 at inception.
ENDORSEMENTS ATTACHED TO THIS POLICY: IL 00 21-Broad form Nuclear Exclusion(Not applicable in New York)
CAOOO11293 CA02200594 CA20181293 CA21520994 E0207-ED1 ILOOO30689 ILOO171185
ILOO211185 IL01670792 IL01800695
LOSS PAYEE
COUNTERSIGNED ;}, k'tU'P7 BY J--4tt u&----
'(Date) I Authorized Representative
~6-5190 3RD EDITION lZ-91 - E.9Z PAGE 3 OF 3
,. . . .
.
Dear Policyholder,
This notice has been prepared in conjunction with the implementation of changes to the Commercial Auto portion of your policy. It contains a brief
synopsis of the significant broadenings, restrictions and clarifications of coverage that were made in each policy form and endorsement listed in
this notice. This notice does not, however, reference every editiorial change made in these forms and endorsements,
Broadenings In Coverage The net effect of combining the liberalized OBNI exclusion and the Other
Audio, Visual and Data Electronic Equipment Coverage Insurance "excess escape" language is a broadening of coverage.
This program extends coverage for electronic equipment which can be Clarifications of Coverage
easily removed from the auto as an anti-theft measure. This program Duty To Defend
also provides insureds the option to purchase additional coverage for The duty to defend language in the Commercial Auto Coverage Forms
more sophisticated and expensive high-tech electronic equipment. The and multistate endorsements has been revised to clarify that:
need for the equipment to be permanently installed in an auto has thus
been eliminated. . the insurer defends an insured named in a "suit," as opposed to
The following endorsements are used in this program: defending the "suit" itself; and
. the purpose of the "suit" is to seek damages for "bodily injury" and
CA 00 01 12 93-Business Auto Coverage Form "property damage" to which the insurance applies.
CA 00 05 12 93-Garage Coverage Form The following coverage forms contain this language:
CA 00 12 12 93-Truckers Coverage Form CA 00 01 12 93-Business Auto Coverage Form
CA 99 37 12 93-Garagekeepers Coverage CA 00 05 12 93-Garage Coverage Form
CA 99 60 12 93~Audio, Visual And Data Electronic CA 00 12 12 93-Truckers Coverage Form
Equipment Coverage CA 25 08 12 93.Personal Injury liability Coverage-Garages
CA 99 61 12 93-Loss Payable Clause-Audio, Visual
And Data Electronic Equipment CA 25 14 12 93-Broadened Coverage-Garages
Definition of "Suit" CA 99 37 12 93-Garage Keepers Coverage
The definition of "suit" in the Commercial Auto Coverage Part has been Racing Exclusion
broadened to include, in addition to arbitration proceedings, alternative A Racing Exclusion was introduced in the following forms to clarify that
dispute resolution proceedings in which the insured and insurer agree coverage for organized racing, speeding or stunting activity has never been
to participate. The coverage forms affected by this change are: contemplated within the Commercial Auto Program:
CA 00 01 12 93-Business Auto Coverage Form CA 00 01 12 93-Business Auto Coverage Form
CA 00 05 12 93-Garage Coverage Form CA 00 05 12 93-Garage Coverage Form
CA 00 12 12 93- Truckers Coverage Form CA 00 12 12 93- Truckers Coverage Form
Fire Damage Legal Liability Endorsement CA 99 03 12 93-Auto Medical Payments
The scope of coverage for Fire Damage Legal Liability has been Garage Liquor Liability Exclusion
broadened by specifying that coverage exists for situations in which CA 00 05 12 93~Garage Coverage Form-the liquor liability exclusion has
an insured is given permission to occupy a portion of a building without
the transfer of rent in the form of money. been revised to clarify it applies to all premises that have a liquor liability
exposure regardless of whether the named insured is the owner, lessor
Owned-But.Mot-lnsured Exclusion of lessee of the premises.
CA 21 17 12 93-Uninsured Motorists Coverage has been revised as Clarification of Definition of Personal Injury and Revisions For
follows: The owned-but-not-insured exclusion has been liberalized by Consistency with Commercial General Liability
applying this exclusion only to the insured responsible for insuring the The following revisions have been made to track with language contained
occupied vehicle, if such insured fails to insure the occupied vehicle.
Therefore, an insured who occupies an uninsured family member's car in the CGL program and to clarify and strengthen the intent and application
will have coverage under his/her own policy for damages he/she is legally of coverage provided under the Garage Coverage Form.
entitled to recover from the uninsured and underinsured motorists. . Exclusionary language for employment related practices when personal
Other Insurance-Excess Escape injury is the trigger for coverage has been built directly into the Garage
CA 21 17 12 93-Uninsured Motorist Coverage-In conjunction with the Coverage Form and CA 25 08 and CA 25 14.
implementation of the liberalized OBNI exclusion "excess escape" · The format of the Pollution Exclusion in the Garage Coverage Forms
language has been added in the Other Insurance provision. This "excess has been revised to clearly indicate it applies to the entire exclusion.
escape" language states that when other uninsured motorists/underinsured · Definitions of "products" and "work you performed" in the Garage
motorists policies are available to the insured, the total recovery for Coverage Form have been revised to include language regarding the
damages will be capped at the highest applicable limit for anyone vehicle. "providing of or failure to provide warnings or instructions."
:25.266J 5.')5 I ni 1 IPP (over) .
-
.. .
,
. The definition of "personal injury" has been revised to track with CGL The forms affected by these changes are:
language. CA 00 01 12 93-Business Auto Coverage Form
Limit of Insurance-Revised Non-Duplication of Benefits and the
Arbitration Condition CA 00 05 12 93~Garage Coverage Form
The Limit of Insurance provisions in the Commercial Auto Coverage Forms CA 00 12 12 93-Truckers Coverage Form
and multistate endorsements have been revised to replace the damages CA 21 17 12 93-Uninsured Motorists Coverage
offset language with revised non~duplication of benefits language. Such
revised non~duplication language serves to clarify that an insured will not CA 99 03 12 93~Auto Medical Payments
receive larger payment than is needed to pay for damages sustained. The addition of the Motor Carrier Coverage Form has resulted in a new
The Arbitration condition in CA 21 17-Uninsured Motorist Coverage was edition date for most of the CA endorsements as 'Motor Carrier Coverage
revised to clarify original underwriting intent, which is that issues conceming Form' now shows on these endorsements as one of the Coverage Forms
whether there is. coverage under the endorsement are not subject to being modified by the endorsement. The Business Auto, Garage and
arbitration. Truckers Coverage Forms have been modified as described above.
,-
-
, . "-- ,
GALLATIN COUNTY FIRE PROTECTION MUTUAL AID AGREEMENT
SIGNATURE PAGE
~t!. cJ :-r;.;~,v~,~.~ r" L.- O~t~.
orga lzatlon
CA-t ;~(,,,.v~~tt-J __ / 1/ /
--I / ---- 9~9-(l?
/ -;;:-: s: ,
Title F" CJ.. \l Signature Date
lY(..., ~ ..&- .- //-
Organization
Title Signature Date
Organization
Title Signature Date
organization
Title Signature Date
Organization
Title Signature Date
.. ,
-..
MONTANA MUNICIPAL INSURANCE AUTHORITY
MEMORANDUM
OF
LIABILITY COVERAGE
MEMORANDUM #
L-0096-97
DECLARATIONS
ENTITY COVERED: CITY OF TOWNSEND MONTANA
ADDRESS: 129 SOUTH SPRUCE
TOWNSEND, MT, 59644
COVERAGE PERIOD: FROM: JUL I. 1997 TO: JUL I. 1998 12:01 A.M.
DEPOSIT PREMIUM: S7.244.
DEDUCTIBLE 5750. PER OCCURRENCE
"
MAXIMUM POLICY LIMIT:
( a) $750,000 for an Occurrence which arises or derives from
injury to or death of a single person, or damage to
property of a single person, regardless of the number of
persons or entities claiming damages thereby.
(b) $1,500,000 for each Occurrence which does not fall under
(a) above,
Endorsements Attached:
By DATE JUL, 1. 1997
.. . . ,
E M P L 0 y E E N 0 T I C E
WORKERS1 COMPENSATION INSURANCE COVERAGE
-
CITY OF TOWNSEND
CITY CLERK
129 S SPRUCE Date: 06/07/97
TOWNSEND MT 59644-2509
Policy No.: 03-0003-77-6
L -- Unit No.: 2
I
The above-named employer's workers' compensation insurance coverage is active and in good standing for
the period of 07/01/97 to 06/30/98 , provided the employer meets all premium and reporting
req u irements. Should the insurer cause a cancellation during the above policy period, the employer will
be furnished an "EMPLOYEE WARNING" sign that must be placed over this sign 20 days prior to final
cancellation action. If the employer goes out of business or transfers ownership or insurance carriers.
the coverage may cease automatically.
Employees should report all on.the-job injuries to their supervisor, insurer, or employer as
soon as possible. You must report the accident within 30 days. We recommend you report minor injuries to your
employer whether or not you receive medical treatment. You must submit a written claim for benefits within 12
months from the date of the accident. You can submit this form to your employer, your insurer, or the Department
of Labor and Industry. After you report the injury, your employer has 6 days to notify the insurer.
All employees other than those who fall in the exempt categories listed below are covered for medical
and wage-loss benefits that may be required as a result of an injury or occupational disease incurred during this
period and in the course of employment of the above named insured:
1; household and domestic employees: departments as described in 7.33-4109, and persons who
2) casual employees performing duties not in the usual course provide ambulance services under Title 7, Chapter 34. Part 1
of trade. business. profession or occupation of the employer, 12) corporate officers and managers of manager.managed limit.
n. ........4 I:....~jljh. ...~~_~~;~~ ...~_ _~~~ ~l..._ __ :.:___ .c 1"\""'. ~^..
. .
GALLATIN COUNTY FIRE PROTECTION MUTUAL AID AGREEMENT
SIGNATURE PAGE
/VI Ci J. 5.) ~ V,) 1< >1 t '" "<< ( r. " ( D..-r t-.-... L" f-
organization J cQ~~4!12
~~ (La ; .- .t--~---- ~)
Title signatv Dat
Organization
Title Signature Date
Organization
Title Signature Date
organization
Title Signature Date
Organization
Title Signature Date
"-
s:l
...
1-
...
,....0
~~ MACoIJPIA
w MONTANA ASSOCIATION OF COUNTIES
-(9
><1
!l.. JOINT POWERS INSURANCE AUTHOIUTY POOL
-
i
Thi I ctltififl that Ml4iIIKI C..al)' i. . JDtlIJiIer of the Montma ~OD of Couaties T oinl P DMJ slnsunnce Authority Pool (MAC4'JPlA)
ud .. MOb is provided Mth the tilowirt ~ covenp:
)-
l- . Property tDaInzII;e
Z
:J . QaMn1. UabWtJ iau1Doe
0
u -
. AJ:4o UIbiitr iaNn,oDe
z
0 . Law ~~ I1abDity irw.nI1c4
(J)
H . EtnK1 and Omissiom iD.suru1ce
0
<I C
:a: u . Crime Cavenge I.
~ . Baier and ~binery
. WeecUPnylRi LiahiIity
, TbeJc t~ m provided.fot \he "mod 7/1m - 7(lJ9I. Coveri8e liraiU ~ irttaChed to lhiJ cc:rti.fi.c:ltC. Covenge exiJ1J for aU COUJJty
( e
., empl(l yt&5 ICtirtI w1thia \he ICOJl e al thctr duties. Questions abou1 co\'cn.ae shDul d be Jddra.Jcd to MACo'JP I.A. 2711 Airport RoAd. HcltnA,
> H
~ Zl MT ~ 9(iO I (406--i41.-7114) to tI1e B1teGlion of Gn:S J acbon.
~3
f11 -',
'<3'.... i. The 1.imft of Crime Covuqe (1500,000) i.I provil!ed Cor aU county I!IDployecs and . aumbu DC specific toWXy.~d officu. i:ntiudUJg
(D 0,
J, ,-,l ~etlDd &: .ppointed officiall ..wo Ire rcquinld by la'PI to be bofdcd upon wumption of \hrir otfite. 'I"bi.5 incJud~ bu ~ ia DOt liuittd to the
(5J zl
'<3'u.. CoUawins pos4tiotui: Com:rmuionm, Tra9UfU', Shtrifl; Ouk a: bxlrder, Oak: of Court, JustK:e af Pace.. C t\UDruy, e\c..
I
...... 1:
<I.
~
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.. .
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.. (
...... l"- Chg .
N (1'l
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------- -------.... n. .__ --.--
1218/12/1997 /21: 31,' 1-41216-843-5517
MAY 20 '97 10:20AM FNI DILLON MAD I SON COUI'H'I PAGE!: 82
" -
11. l>>IJtZ 0' UABtt.STT:
,
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t. ,~V.....,.., 1'\Ill ~.It ud r~w;c.moIlllc:..llll\ ~_ ~ ~....t~.----
.qulp....... -"Ides, .......lI: ~ ..-.:I brilla'" :1,/11 0lI an _I .... -- WiI:
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3. SYJ.OCC,lXXl PIa"",,, IIml. tn ..Inall l)Q'U.....,.... .-llll- ....,.a
D. Bellar ID4 ......bialll)'
1. BIa_r, all riD ro, 1lI1 JIl'OP"'RY In _/'Itch , ~r" u ~ ......
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1, E..-or>" nt.zMlllCro' ... rtd\blW ,..Ab....._ - S'lIJ.~"'-':
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(WI"" fIm:IlI n-r"r l"ruui appU",,)
All p..~JCrUllUBOller ~ Muhll'lt"f _wcrqIILI rlml.. -' ~.. ......II!W. ...scll~ Jat "r ,,,,.CD) _h
In! .....,. IClll.nd oa alI/I\l.l1 .p"'s.... tar III 'lIropcrtr ell".... '1f11115,_. n. ~ IfIIlnlll_. 4lld&Edbl.
..._ plr ~1Ee.
A. S. ,~ tD:l. rllr ....,11 <o1.1rD ,rd 1.5 mm_ fW -".... --
\)~\1 >>. s .000. r;Ildl P'twll.
S. '0 lD:). ..ell _ldo:nr.
\...,\~ C. ~ '15Q.a.II for GIld> ..Ialm lIniS 1.'mmla:lft *" ... __a
Tba .boo- I...... .". aat>j..t -, .,. "lIoWln. ~lrhmallinoi-=
S 1 tEID me il\lSlic ,"",..II: ....-It)' ~ ~ ....-...... ."dl'ftl pu -"..-
S , [IX] b:ID ill 1h.a -aIt.,.lIt ..-:mill" J~ d.......... D u........ ~r mDl'ClIIr _l...uq..
aeJIIB" SJ,lJ::lO.(J;:IJ __I ....... -.Ia .
SImISon lJl A, 1I "T"'V'\ 0Cll for.-ll dllm ..lid l.~ n&1- fbto ~ -. ../,jloI.
II. ~ ,alO ...11 ,.......
$ 30.0. -..:Iuwddl.
c. ,_ ''II em rar .uJ\. d..lm.~ \.1 J9d1"- .....---
5Ktlon l:V 1 11ll aICI fllr dFlI e!all'tl ..ad. I.' ..W" .... -- .-na'1&&
A. &.ft'G...... 1I''d''tIII..bl~~
~r... liI:Ir aU 1i&\ll1IlW l:""C/lP for s.cDCII\! u.m a:d PI pol' II.. MA.Com'lA ___.... "'. ",oqlI~ ~, ....ia...~ -....
,..",ICI~l1 by sla~ S... 1.1 lS.M'l,OOO iA IIlio> "",I~ . .p,,al.OOO larIlIU....... l i ~II(!,. In ~... fA llI'J ...nsIIlIr ~
Ww;.tible.
l M...co! IPlA-lJ1.?6
-
. I .
'" ~
GALLATIN COUNTY FIRE PROTECTION MUTUAL AID AGREEMENT
SIGNATURE PAGE
j }/!tuJ r,RQ@.. ,k CtA -zIlL h;J.vD,:;.7
organization '
r/" l'~ F '--St~f;,q" 1
h' () ,/.6~A ? Jlt /9'1
/t?'f'
Title " ,f) a,:t e /
Organization
Title Signature Date
Organization
Title Signature Date
organization
Title Signature Date
Organization
Title Signature Date
J . EMC IT- -urance Companit
.-- -
BUS I N E S S PRO T E C T ION POL ICY
COM M 0 N o E C L A RAT ION S
POLICY PERIOD
FROM: SEE SECTION DECLARATIONS TO: 12/28/97 *------------------------*
I 12:01 A.M. STANDARD TIME * POLICY NUMBER *
I -"
"--- AT YOUR MAILING ADDRESS SHOWN BELOW * 0 X 5 - 8 8 - 0 4---97 *
(UNLESS CHANGED ON THE SECTION DECLARATIONS) *------------------------*
N A M E D INS U RED : PRO 0 U C E R :
~ - ~ ~ - - ~ ~ - - - - - - - ~ - - - ~ ~ - ~ ~ - -' - - - - - - - - ~ ~ ~
WILLOW CREEK RURAL FIRE WESTERN STATES INS. AGENCY, INC
DEPARTMENT 140 EAST MAIN
BOX 113 PO BOX 430
WILLOW CREEK, MT 59760 BOZEMAN, MT 59771-0430
AGENT NO: P-7350
AGENT PHONE: (406)586-3351
- ~ ~ - - - - - - ~ ~ - - - - - - - ~ - - ~ - - - - - - - - - - - ~ - - -
INSURED IS: FIRE DEPT BUSINESS DESC: FIRE DEPARTMENT
- ~ - - - - - - - - ~ - - - ~ - - - - - - - - - - ~ - - - - - - - - - - -
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF
THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS
POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A
PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. THE
COMPANY AFFORDING COVERAGE IS DESIGNATED BY THE NAME IN THE DECLARATIONS
OR INFORMATION PAGE FOR EACH SECTION OF THE POLICY.
~ ~ ~ ~ ~ - - - ~ - - - - - - ~ ~ - - ~ - - - ~ ~ - - ~ ~ ~ - ~ - - - ~ ~
S E C T ION C 0 V ERA G E' PRE M I U M
.... -~-~~-~~~---- ---~~-----~--------~~ ------.-........-----
1 PROPERTY $ NO COVERAGE
2 LIABILITY 207.00
3 CRIME . NO COVERAGE
4 INLAND MARINE . NO COVERAGE
5 AUTOMOBILE . 2,087.00
6 WORKERS' COMPENSATION NO COVERAGE
7 . UMBRELLA . NO COVERAGE
8 OTHER - LINEBACKER 433.00
-~~~~-~~----~~-~~~-~---~~~----~-~~-~-----~---~-~------~-------------~~-
ESTIMATED TOTAL POLICY PREMIUM ,.. 2,727.00
;;I
-------------------~~------~---_._---~--------------_.---~---------------
FORMS APPLICABLE TO ALL SECTIONS EXCEPT;
1. WORKERS' COMPENSATION
2. WHEN EXCLUDED ON SECTION DECLARATIONS
ILOO17(11/85) IL7004(3/94) IL7050(9-90)
~ THE ADDRESS AND TELEPHONE NUMBER OF THE SERVICING COMPANY IS:
EMC INSURANCE COMPANIES PHONE: (701) 223-8986
P. o. BOX 1897
BISMARCK, NO. 58502-1897
PLACE OF ISSUE: BISMARCK, NO
.
FORM; IL7000A (ED. 09-96) 96 ('
) EMC Irc-urance Companit
.vAL CASUALTY COMPANY PRIOR POLICY: OD5-88-04
G ENE R A L L I A B I LIT Y D E C L A RAT ION S
>,
~LICY PERIOD: *------------------------*
;1 FROM 12/28/96 TO 12/28/97 * POLICY NUMBER *
* 0 D 5 - 8 8 - 0 4---97 *
*------------------------*
N A M E D INS U RED: PRO D U C E R:
- - ~ ~ ~ - ~ ~ - - - ~ ~ - - - ~ - - - - - ~ ~ - ~ - - - - - - - - - - ~ ~ ~
WILLOW CREEK RURAL FIRE WESTERN STATES INS. AGENCY, INC
DEPARTMENT
140 EAST MAIN
BOX 113 PO BOX 430
BOZEMAN, MT.
WILLOW CREEK, MT. 597710430
59760 AGENT NO: AP-7350-4
DIRECT BILL
- - - - - - - - - - - - - - ~ - - - - - - - - - - - - - - - - _. - - - - - - -
INSURED IS: FIRE DEPT BUSINESS DESC: FIRE DEPARTMENT
- - - - - ~ - - - - ~ - - - - - - - - - - - - - - - - - - - - - - - ~ ~ - - ~
LIMITS OF INSURANCE
GENERAL AGGREGATE LIMIT (OTHER THAN PRODUCTS / COMPL OPS) $ 1,000,000
PRODUCTS/COMPLETED OPERATIONS AGGREGATE LIMIT $ 1,000,000
PERSONAL AND/OR ADVERTISING INJURY LIMIT $ 500,000
EACH OCCURRENCE LIMIT $ 500,000
FIRE DAMAGE LIMIT (ANY ONE FIRE) $ 100,000
MEDICAL EXPENSE LIMIT (ANY ONE PERSON) $ 5,000
~----------------------------------------------------------------------------
C 0 V ERA G E S PRO V IDE D PRE M I U M
~~-------------------------------- -,---------~- -
OTHER THAN PRODUCTS/COMPLETED OPERATIONS $ 207.00
--------------------------------~----~--~-~--~~~--
TOTAL ESTIMATED POLICY PREMIUM $ 207.00
-----~-~~-~---~--~---~~~-------------------------~
-----~-~~~-~~~~~-~~~~~-~--~~~----~~-~~~~~~~~-~~-~--~~~-~~~~~~--~~~--~----~----
SEE ATTACHED SCHEDULE FOR LOCATION
OF ALL PREMISES OWNED, RENTED OR OCCUPIED.
------~-------------------------------------------------------~-----------~---
FORMS APPLICABLE:
CG7001A(01-86) CG7003(03-96) CGOO01(01-96)
CG2147 (10-93) CG2150(09-89) CG2021(01-96) -
CG2256 (01-96) CG7128(08-88) CG7129(08-88)
IL0021 (11-94) IL0243(06-89) IL0167(07-92)
~ IL7039 (09-89) CG8057(01-96)
~ ~,~ ~
,_It-\!L:. vr: .!.'-''-'Vl,;,. .!.,-/J..,-/7V orr
FORM CG7000A ED.01-86 11/11/96 002 SL On'iRRn4 Q7n1
I . .
GALLATIN COUNTY FIRE PROTECTION MUTUAL AID AGREEMENT
SIGNATURE PAGE
c; /~f/~ 6~ft:W4-7 Ff;e
Organization / ~ i/;?
~hd'''/'- tH~ ~
Title ~ S, nature !
Organization
Title Signature Date
Organization
Title Signature Date
Organization
Title Signature Date
Organization
Title Signature Date
I . . ~'.
A4~4.1!1..G~a]I~It3~-E~~tilm~It3If1~e, ISSU~ DAT~ (MM/DDIYY)
1 03/05/98
PROOUC~R THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CENTRAL INSURANCE AGENCY CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
161 WEST MADISON POLICIES BELOW.
PO BOX 1170 COMPANIES AFFORDING COVERAGE
BELGRADE, MT 59714-1170
~--~~_._---_._, ,~.~~-_. .,--_.., _.._._.n,
COMPANY A EMPLOYERS MUTUAL INS CO
LETTER
~-- ...-.. -.------.--.....---- ---....--.-
_______ __m_____ '" _, .-_ COMPANY B
INSURED LETTER
.--. -""'.,-.-.- .. _n __..___...
GALLATIN GATEWAY RURAL FIRE DISTRICT COMPANY C
PO BOX 238 LETTE~__",.,_,_, -..------------- -.---------.------..-
GALLATIN GATEWAY, MT 59730 COMPANY D
LETTER
~.'W.. .n..__.~. -- -----------.----.. ...-..--
COMPANY E
LETTER
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 POLlCIES_ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_
~T~I --.- ..~. --~,^'.~ .'-~~- POLICY EFFE~TIV~ POLICY EXPIRATION \- .... ."" .-... __...n
TYP~ OF INSURANCE; POLICY NUMB~R OATE (MM/DDIYY) DATE (MM/DDIYY) LIMITS
A G~N~RAL LIABILITY GENERAL AGGREGATE $ 1,000,000
I _",J_'... .._.
X I COMMERCIAL GENERAL LIABILITY 9D6863699 02/07/98 02/07/99 PRC?DUCTS,COMf'/OflfGG -f $ 1,000,000
--'Ji CLAIMS MADE[i] OCCUR, PERSONAL & ADV. INJURY S 500,000
,"'---- OWNER'S & CONTRACTOR'S PROT_ ~,.,.".'- '1-"
EACH OCCURRENCE 1$ 500,000
r.-'- '~;~E DAMAGE (At:y~n~
~~() SUBLINE c;_9_~ 100,000
MED. EXPENSE (Anyone p8r"onJ! $ 5,000
rr"'~ ","'UTI I
COMBINED SINGLE-+-
ANY AUTO LIMIT
..... " --,-
I ALL OWNED AUTOS BODILY INJURY . l $
--~J SCHEDULCO AUTOS (Per person)
.' ..-.,."-,.,,,.
__ml HIRED AUTOS BODILY INJURY L-
i NON,OWNE::D AUTOS (Por nccident)
--1 GARAGE LIABILITY I
n PROPERTY DAMAGE is
i
I EACH OCCURRENCE $
I EXl;~SS LIABILITY .----..
H UMBRELLA FORM S
.... -- ---
I OTf-lER THAN UMBRELLA FORM
I I STATUTORY LIMITS i
WORKER'S COMPENSATION CAC"'m"N'-~~ ~
AND
EMPLOYERS' LIABILITY ~:::::::::~I~:~~~~;~ ; :___'
Onl~R
DESCRIPTION OF OP~RATIONS/LOCATIONS/VEHICLE;SISP~CIAL ITEMS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
GALLATIN COUNTY MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
311 WEST MAIN STREET LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
ROOM 100 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES,
BOZEMAN, MT 59715 AUTHORIZED REPR~S~N
I . .
~
GALLATIN COUNTY FIRE PROTECTION MUTUAL AID AGREEMENT
SIGNATURE PAGE
Crk/t( ~ IIc~'("" Co -.zJ I
Organlz tlon
C;'AfP/"M~ . ILJ~JU- ~> Lf/9 7
Tltle signature ' Date
organization
Title signature Date
Organization
Title Signature Date
Organization
Title Signature Date
Organization
Title Signature Date
l J .. . . ,-- EMC Insurance COlupanie:
-~ BUS I N E S S ROT E C T ION POL . C Y
COMPION D E C L A RAT ION S
POLICY PERIOD
FROM: SEE SECTION DECLARATIONS TO: 02/01/98 *------------------------*
12:01 A.M... STANDARD TIME * POLICY NUMBER *
.... AT YOUR MAILING ADDRESS SHOWN BELOW * 0 X 7 - 7 8 - 4 1---98 *
~(UNLESS CHANGED ON THE SECTION DECLARATIONS) *------------------------*
N A M E D INS U RED : PRO D U C E R :
~ - - - - - - - - - ~ - - - - - - - - - - - - - - - - - - - - - - ,- - - .-
GATEWAY HOSE COMPANY 1 WESTERN STATES INS. AGENCY, INC
GARDINER VOL. FIRE DEPT. 140 EAST MAIN
POBOX 307 PO BOX 430
GARDINER, MT 59030 BOlEMAN, ~T 59771-0430
AGENT NO: P-7350
AGENT PHONE: (406)586-3351
- ~ - - - ~ - - ~ - - - - - - - - - - - - ~ ~ - - - - - - - - ~ - - - - -
INSURED IS: FIRE DEPARTMENT BUSINESS DESC: FIRE DEPARTMENT
- - - - - - - - - - - - - - - - - - - - - - - - '- .- - - - - - - - - - - --
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF
THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS
POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A
PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. THE
COMPANY AFFORDING COVERAGE IS DESIGNATED BY THE NAME IN THE DECLARATIONS
OR INFORMATION PAGE FOR EACH SECTION OF THE POLICY.
- ~ - - - - - - - ~ - - - - - -, - - - - - - - - -, - - - - - ~ - - - - ~ -
S E C T ION . C 0 V ERA G E . PRE M I U M
~----_........_------ . -- -.-.---- -.--........---.-..-.- --- . ~------------
'-,.; 1 PROPERTY $ 270.00
. .
2 . LIABILITY . 391.00
3 ... CRIME . NO COVERAGE
4 . INLAND MARINE . 1,064.00
5 . AUTOMOBILE . 3,588.00
6 . WORKERS' COMPENSATION . NO COVERAGE
7 . UMBRELLA . 775.00
8 . OTHER - LINEBACKER . 431 .00
. .
. .
. .
- .
. .
. .
... .
---------~._._-~---------_._.__._----_._-_._----~--_.-_._-~._--_.__._._~----_._,._~---~--
. ESTIMATED TOTAL POLICY PREMIUM . $ 6,519.00 .
----~_._---------~--,._---,_.__._--_._-_._._---,_._._~~-,_._._-,---_._.__._-_._._._._._---_._._._~_._---
FORMS APPLICABLE TO ALL SECTIONS EXCEPT:
1. WORKERS' COMPENSATION
2.. WHEN EXCLUDED ON SECTION DECLARATIONS
ILOO17(11/85) IL7004(3/94)
THE ADDRESS AND TELEPHONE NUMBER OF THE SERVICING COMPANY IS:
\ . EMC INSURANCE COMPANIES PHONE: (701) 223-8986
P. O. BOX 1897
BISMARCK, ND. 58502-1897
PLACE OF ISSUE: BISMARCK, ND
"- DATE OF ISSUE: 01/24/97 COUNTERSIGNED BY: /
FOKM: IL(UUUA (tV. UY Yo) U'l/t!.4/Y( ll:l Ox (( 84 "' 98
I . EMC In~urance COlnpanic:
.
.---~
EMPLOYERS MUTUAL CASUALTY COMPA,.. PR lOR I LICY: OD7-78-41
G ENE R A L L I A B I LIT Y DEe L A RAT ION S
I * -- _.- - _._- - - - - - ----- ---- - - *
'-LICY PERIOD: FROM 02/01/97 TO 02/01/98 * POLICY NUMBER *
I
! * 0 D 7 - 7 8 - 4 1---98 *
*------------------------*
N A M E D INS U RED: PRO D U C E R:
- ~ - - ~ - - - - - -' - - - - - - _. - - - -, - -. -. - - - - - - - - _. - - - - -
GATEWAY HOSE COMPANY 1 WESTERN STATES INS. AGENCY, INC
GARDINER VOL. FIRE DEPT.
140 EAST MAIN
POBOX 307 PO BOX 430
BOlEMAN, MT.
GARDINER, MT. 597710430
59030 AGENT NO: AP-7350-4
AGENCY BILL
- - - - - -. - - - - - - -, - - -. - - _. - - - - - _. - - - - - - - - ~ - - - - -
INSURED IS: FIRE DEPARTMENT BUSINESS DESC: FIRE DEP/l.RTMENT
- - - - - - ~ - - - ~ - - - - - - - - - - - - - - - - - - - -, - - - - - ~ - ~
LIMITS OF INSURANCE
GENERAL AGGREGATE LIMIT (OTHER THAN PRODUCTS / COMPL OPS) $ 2,000,000
PRODUCTS/COMPLETED OPERATIONS AGGREGATE LIMIT $ 2,000,000
PERSONAL AND/OR ADVERTISING INJURY LIMIT $ 1,000,000
EACH OCCURRENCE LIMIT $ 1,000,000
FIRE DAMAGE LIMIT (ANY ONE FIRE) $ 100,000
MEDICAL EXPENSE LIMIT (ANY ONE PERSON) $ 5,000
~." - - --.---- - -- - - -- --- -- -'- -- ---- - - _.- ------- ,--- - ---.-- -------~-- - .---- -_._- -- .-----.-.- - --- --- --- - - - ----
C 0 V ERA G E S PRO V IDE D PRE M I U M
......... ~ - - ~ ~ ~- ~ -- - - -- -- ~~- -.... -_.........~ .......--~ .........----.-"- -- ~ ~ ~ ~ -_. - -- - - ~.- - - - ~ - - -
OTHER THAN PRODUCTS/COMPLETED OPERATIONS $ 391 .00
...- ~ ~._-- ~-- -.- -- -.- - ~-- -'-- ~._'._--~- --,~...-......... ........- -- ---- -- ......... ~,.-.- -.-- -.-- - - ~ - ,- - - - --
TOTAL ESTIMATED POLICY PREMIUM $ 391 .00
- ~~----.........- -..... ...,~~- ~--~--~_._'.- ._.........._-~ ~- ~~_.- ---_.__._-_.~--~.......-~--~~---- --.........---
~~_________________._~~____.__.~__9__.___~__._._~~_~_~_~____~_~___.______y_______~_____
SEE ATTACHED SCHEDULE FOR LOCATION
OF ALL PREMISES OWNED, RENTED OR-OCCUPIED.
- - - - -- - - -- -~ ~~....... ---~ ~~ ........... _.- ~ --.- _.- --........ --.............................. --....... ....................... -- --........--............................... -- -- .......~-,,-_.~.- _......... .-....... ~ ----.- .-.- -.- - - - -.- - -- ~ - ---
FORMS APPLICABLE:
CG7001A(01-86) CG7003(03-96) CGOOO1(01-96)
CG2147 (10-93) CG2150(09-89) CG2256(01-96)
CG2021 (01-96) CG7128(08-88) CG7129(08-88)
CG7110 (01-86) IL0021(11-94) IL0243(06-89)
G' IL0167 (07-92) IL7039(11-93) CG8057(01-96)
-
~DATE OF ISSUE: 01/24/97 BPP
FORM CG(OOOA ED.U1-86 01/06/97 002 C8 OD71841 9801
r-----., .. : , EMC In.SJ,lfance Conlpanie~
EMPLOYERS MUTUAL CASUALTY COMP",. it PRIOR JLICY: OC77841
COM MER C I A L I N LAN D MAR I N E D E C L A RAT ION S
*------------------------*
t......DLICY PERIOD: FrWM 02/01/97 TO 02/01/98 * POLICY NUMBER *
* 0 C 7 - 7 8 - 4 1---98 *
*------------------------*
N A M E D INS U RED : PRO D U C E R :
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - _. _. - - - - ~
GATEWAY HOSE COMPANY 1 WESTERN STATES INS. AGENCY, INC
GARDINER VOL. FIRE DEPT.
140 EAST MAIN
POBOX 307 PO BOX 430
BOlEMAN, MT
GARDINER, MT 59771-0430
59030 AGENT: AP-73S0-4
AGENCY BILL
- - -, - - - ~ - - - - - - ~ - - - - - ~ _. - - - - - ~ ~ - - - - - - - - - -
INSURED IS: FIRE DEPARTMENT BUSINESS DESC: FIRE DEPARTMENT
- - - ~ ~ - - - - - - - ~ - ~ - - - - ~ - - - - - - - - - - - - - ~ - - - -
SEE ATTACHED SCHEDULE FOR DESCRIPTION OF
COVERAGES
- -- --.- --........----- ------- -------_._-_._---- - --.........
C 0 V ERA G E S PRO V IDE D L I M I T PRE M I U M
-------------------------~~---,-----~~~~~------_.- -------~---- --------------
MISCELLANEOUS PROPERTY CN.O.C.) $ 122,306 $ 1,064.00
--~----------------~-,--~--------------,-----,----~~-~---_._-------~-----------
TOTAL INLAND MARINE PREMIUM $ 1,064.00
L... ~~------------~----_._-------------,~~_._------
A DEDUCTIBLE MAY APPLY FOR THE COVERAGE PROVIDED. IN THE EVENT A LOSS
COTHER THAN EARTHQUAKE) INVOLVES COVERED PROPERTY AT MORE THAN ONE
LOCATION OR IN MORE THAN ONE CLASS, ONLY ONE DEDUCTIBLE, THE LARGEST
DEDUCTIBLE SHOWN ON THE SCHEDULE FOR THE LOCATION OR CLASSES INVOLVED
IN THE LOSS, WILL APPLY PER OCCURRENCE.
~----------'-~-~--------------~------_._---_.~~~-----------------~-~--~------~
FORMS APPLICABLE: CM7001AC11-88), CM7002C01-86), CMOOO1C06-9S),
CM7321C10-92), CM7010C01-86), CM701SC02-93),
CM7323C03-90), IL0243C06-89), IL0167C07-92),
IL0180C06-9S), ,CM80COC12-9S)
~ ~ - ~ ~ ---. -.- ~-~-- --,~~.........................- ~ -- ..-'--- -.- - -,-~ ~.............. ...........---.-.- ~ - - ~ ---- -............. -... ---- -- ~ - -,- -~ -~-~ .--- -- -.-.........-----............... - -- ---
\v
""'- DA TE OF ISSUE: 01/24/97 CBPP)
/
FORM: CM(UUUA ED. 1 86 U1/U6/9( 002 CB UCll~41 <;8U1
I . EMC Insurance COHlpanie
---
EMPLO'i,Q..R.&-MUTUAL CASUALTY COMF-.. ,y PRIOR JLICY: OE7-78-41
COMMERCIAL AUTO DECLARATIONS - BUSINESS AUTO COVERAGE FORM
*------------------------*
(;OLICY PERIOD: FROM 02/01/97 TO 02/01/98 * POLICY NUMBER *
* 0 E 7 - 7 8 - 4 1---98 *
ITEM ONE: *------------------------*
N A M E D INS U RED ,. PRO D U C E R :
~ ~ ~ - ~ ~ - - - - - - - - ~ - - - - - - - - - - - - - - - - - - ~ ~ - - - -
GATEWAY HOSE COMPANY 1 WESTERN STATES INS~ AGENCY, INC
GARDINER VOL~ FIRE DEPT.
140 EAST MAIN
POBOX 307 PO BOX 430
BOZEMAN, MT
GARDINER, MT 59771-0430
59030 AGENT: AP-7350-4
AGENCY BILL
- ~ ~ - - - - - - - - - - - - - - - - ~ - - - - - ~ - - ~ ~ - - - - - - - - -
INSURED IS: FIRE DEPARTMENT BUSINESS DESC: FIRE DEPARTMENT
- - - - - ~ - - - - - - - -- - - ~ ~ - -- - - - - - - - - - - - - - ~ - - - ~ -
ITEM TWO: SCHEDULE OF COVERAGES AND COVERED AUTOS
'AUTOS' ARE SHOWN AS COVERED 'AUTOS' FOR A PARTICULAR COVERAGE BY THE ENTRY
OF ONE OR MORE OF THE SYMBOLS FROM THE COVERED AUTO SECTION OF THE COMMER-
CIAL AUTO COVERAGE FORM NEXT TO THE NAME OF THE COVERAGE.
COVERAGES COVERED AUTOS LIMITS/DEDUCTIBLES .. PRE M I U M
LIABILITY 01 $ 1,000,000 .$ 1,748.00
AUTO MEDICAL PAYMENTS 07 $ 5,000 . '130.00
UNINSURED MOTORISTS 02 $ 1,000,000 . 105.00
UNDERINSURED MOTORISTS 02 :]; 1,000,000 . INCLUDED
~HYSICAL DAMAGE (ACTUAL CASH VALUE OR COST OF REPAIR, WHICHEVER
IS LESS, MINUS THE DEDUCTIBLE, FOR EACH COVERED AUTO.).
COMPREHENSIVE 07 SEE ITEM THREE . 688.00
FOR DED.. FOR ALL LOSS. .
EXCEPT FIRE OR LIGHTNING ..
COLLISION 07 SEE SCHEDULE FOR DED.. .. 75 1 . 00
.
PREMIUM FOR ATTACHED ITEMS 4, 5; AND/OR 6 .. 166.00
___ __,.____ ~_r__'___._.__ __ ____~._.___,_~_ "_'_ "__ ._._ ~.___ ~__ _____
ESTIMATED TOTAL POLICY PREMIUM .$ 3,588.00
~-~~-,......... ,- --+"-- ~.~-_._---_._-_._-_._".- ._.~._.~-~-- ,_.~ .....~,--,-~~_._~._._~~ ------
- - - - - - - - - - - - - - - - - - - - - - - - - - .- - - - - - - - - - - - -
FORMS APPLICABLE:
CA7002A(12/93) CA7001A(12/93) CA7007(12/93) CAOO01(12/93)
CA0220 (05/94) CA2152 (09/94) CA9903(12/93) CA2018(12/93)
CA2030 (12/93) CA7223 (12/93) CA7225(12/93) CA9933(12/93)
CA7201 (12/93) CA9916 (12/93) IL0021(11/94) IL0167(07/92)
IL0180 (06/95)
- - - - - - - - - - - - -' - - - - - - - - - - - - - - - - - - - - - - - - - -
'"
INCLUDES COPYRIGHTED MATERIAL OF INSURANCE SERVICES OFFICE, INC..
WITH ITS PERMISSION.
~TE OF ISSUE 01/24/97 (BPP)
RM CAfUUUA ED_ 12 9j U '1 /U6/9? UU2 CB UE70341 98U1
I . EMC hl.SUrance COIllpanie:
, .
EMPLOYERS MUTUAL CASUALTY COI"., "NY PRIOR. OLICY: QJ7-78-41
COM MER C r A L U M B R ELL A DEe L A RAT ION S
" *------------------------*
,....".: POLl C Y PER 100 : FROM 02/0'1/97 TO 02/01198 * POLICY NUMBER *
* 0 J 7 - 7 8 - 4 1---98 *
*------------------------*
N A M E D INS U RED PRO D U C E R
- - ~ - - - - - - - -' - ~ - - - - - - - - - - - - ~ - - - - - - - - - - - ~ -
GATEWAY HOSE COMPANY 1 WESTERN STATES INS~ AGENCY, INC
GARDINER VOL~ FIRE DEPT~
140 EAST MAIN
POBOX 307 PO BOX 430
BOlEMAN, MT
GARDINER, MT 597710430
59030 AGENT NO: AP-7350-4
AGENCY BILL
- - - - - - - - _. - - - -, - - -, -" _. - - - - - _. - - - - - - - - - ~ ~ - - ~ ~
INSURED IS: FIRE DEPARTMENT BUSINESS DESC: FIRE DEPf-\RTMENT
- - - - ~ - - - - - - - - - - - - - - - - - - - _. ~ - - - - - - - - -- - - - -
L I M I T S 0 F L I A B I L I T Y
$ 10,000 RETAINED LIMIT
$ 1,000,000 OCCURRENCE LIMIT
.$ 1,000,000 AGGREGATE LIMIT
-- ~.........................- ~ - -~-- --,- -., - -- - --. - -- -.-.--...... ~~ -~-,--- - --~-~ ................................ ---.-.~ - - --- - ~-~......... --................ --- .................- ~- - - - -- _. - - - --
PREMIUM COMPUTATION:
FLAT PREMIUM CHARGE $ 775~00 (NOT SUBJECT TO AUDIT)
f ,
."'" -~------------~------~-~-~--------------
TOTAL ADVANCE PREMIUM .$ 775_00
-------~--~~-~~-----------~--~_._-----
(THE ADVANCE PREMIUM IS A MINIMUM PREMIUM FOR THE POLICY TERM)
A $100 MINIMUM POLICY PREMIUM APPLIES
IF POLICY IS CANCELLED AFTER THE EFFECTIVE DATE
--~~--------,------------------~------------~-,-~--------------------~-~~~---~--
FORMS APPLICABLE:
CU7001A(11/88),CU7002(10/93)1ST REP,CU7171(11/88),
IL7036 (05/92),IL7062 (07/92),CU7115 (11/88),
CU7179 (11/88),CU7195 (11/88),CU7130 (11/88),
CU7187 (11/88),CU7210 (01/86),CU7215 (11/88)
CU7178(11/88)
L,'
DATE OF ISSUE: 01/24/97 BPP
F ~ U1/U(19f UUL CB UJ((tl41 Y~U1
I~-'.------'-"""- .. . EMC l}l~urance COlupanie:
--
EMPLOYEHS MUTUAL CASUALTY COI"r. I\NY PRIOR.OLICY: OK7-78-41
L I NEB A C K E R D E C L A RAT ION S
*~-----------------------*
PO;"ICY PERIOD: FROM 02/01/97 TO 02/01/98 * POLICY NUMBEH *
,~ * 0 K 7 - 7 8 - 4 1---98 *
*------------------------*
N A M E D INS U RED PRO D U C E R
- - - - - -. - - - - - - - - - - ~ - -.- -. - - - - -. - -. - - - - - - - - - - - -
GATEWAY HOSE COMPANY -1 WESTERN STATES INS. AGENCY, INC
GARDINER VOL. FIRE DEPT.
140 EAST MAIN
POBOX 307 PO BOX 430
BOZEMAN, MT
GARDINER, MT 597710430
59030 AGENT NO: AP-7350-4
AGENCY BILL
........ ...... ...... _. -- - - - - - - - - -. - ~ ..... ...... ........ -- - - - - - -- ~ ........ - - - - - - - - - - -
INSURED IS: FIRE DIST
- - - - - - - - - ~ - - - ~ - - - - - - - - - - - - - - - - - - - - - - - - -
*****************************************************************
* T HIS I S A C L A I M S MAD E POL I C Y *
* P LEA S E REA D CAR E F U L L Y *
*****************************************************************
L I M I T S 0 F L I A B I L I T Y
$ 1,000,000 EACH LOSS
$ 1,000,000 AGGREGATE FOR EACH POLICY TERM
~
$ 1,000 INSURED'S DEDUCTIBLE PER LOSS
-----------~----_._------------------~------------------_._-_._-----~-~~--------
RETROACTIVE DATE AND EXCESS EXTENDED REPORTING PERIOD:
THIS INSURANCE DOES NOT APPLY TO WRONGFUL ACTS WHICH OCCUR
BEFORE THE RETROACTIVE DATE SHOWN BELOW.
RETROACTIVE DATE: 05/01/90
AVAILABLE EXTENDED REPORTING PERIOD: ( 5 YEARS )
--------------------_._--_._---~-~~~~---~---------------_.~-----------~-~_.~_._._-~~
----~--_.__.__._._-----_._._._._._-_._---_._._----
TOTAL ADVANCE PREMIUM $ 431 .00
--------_._--~---~_._.._-~_._-_._._--_._---~----
COVERAGE IS PROVIDED FOR BOARD AND ALL EMPLOYEES
(THE ADVANCE PREMIUM IS A MINIMUM PREMIUM FOR THE POLICY TERM)
A $ 100 MINIMUM POLICY PREMIUM APPLIES
IF POLICY IS CANCELLED AFTER THE EFFECTIVE DATE
~------_._----------------_.__._._~~----~_.__._--------~~--~-~----~-~----~-_.~---_._----
FORMS APPLICABLE:
.....- CL7001 (01/91),CL7110 (10/89),CL8117 (01/91),
IL7036 (05/92),IL7062 (07/92)
- - ~ - -.- ~--- ---..- -.--.- .--.- ~-~.- .-.- ._-.......................~.--~-~ - -------.- .-.-.- - ---.- ~ _._~- .---.--- ---.-....... -- -.-.-.-.............. ---- -- -- --~ -........
DATE OF ISSUE: 01/24/97 8PP
,... UKI"! lL (UUUA I.U6 ~(j) U 'I / 06/ Y ( UU~ L!::l OK? (lj4'1 yljU'1
GALLATIN COUNTY FIRE PROTECTION MUTUAL AID AGREEMENT
SIGNATURE PAGE
l3~ C - rLJf~ J
OrganizatiOnao 4A d,' 9' ~ II - ? 7
~--,-~ a WK
Title Signature Date
JCI E //;i ~,~ q
Organizati n
-~0skC' ft~rP/ %A~
Title 'Date
I
Pfl~ hkE 5ER-uICE /-le_EA-
organization
Ci-l/-l/((mAtJ - BD4R6 -- tJ~ L L4~ o' c;7
oP / t..J.Y;'TeE::~ /-Ire'-
Title Signature Date
organization
Title Signature Date
Organization
Title Signature Date
i . . urance Co'lupanies
. EMC I'
.
EMPLOYERS MUTUAL CASUALTY COMPANY F'RIOR POLICY: 1E1-17-73
COMMERCIAL AUTO DECLARATIONS - BUSINESS AUTO COVERAGE FORM
*------------------------A
\OLICY PERIOD: FROM 06/0 '1/97 TO 06/0-1198 * POLICY NUMBER *
* 1 E 1 - 1 7 - 7 3-,--98*
ITEM ONE: *------------------------*
N A M E D INS U RED : PRO D U C E R :
- - - - ..- -- - - - ~ - - - - - - - .- - - .- - - - - - - - - - - - - - - - - - -
BRIDGER CANYON VOLUNTEER WESTERN STATES INS. AGENCY, INC
FIRE DEPT.
1L,.0 EAS r MAIN
8081 BRIDGER CANYON RD. PO BOX 430
BO Z ErIAN, MT
BOlEMAN, MT 5977 '1-0430
.59715 AGENT: AP-7350-4
'DIRECT BILL
- - - - - - - - - - - - ~ - - - - - - - - - - - - - ~ ~ - - ---~-~~
INSURED IS: FIRE DEPT. BUSINESS DESC: FIRE DEPT.
- - - - - - - - - - - - - - - - - - - - - - - ~ ~ - - - - - - - - - - - - - -
ITEM HJO: ~:;CHEDULE OF COVERAGES MJD COVERED ,1\UT0S
'AUTOS' ARE SHOWN AS COVERED 'AUTOS' FOR A PARTICULAR cOVERAGE BY THE ENTRY
OF ONE OR MORE OF THE SYMBOLS FROM THE COVERED AUTO SECTION OF THE COMMER-
CIAL AUTO COVERAGE FORM NEXT TO THE NAME OF THE COVERAGE.
COVERAGES COVERED AUTOS LIMITS/DEDUCTIBLES . PRE M I U M
LIABILITY 01 $ 1,000,000 .$ 1,455.00
UNINSURED MOTORISTS 02 .$ 100,000 . 55.00
UNDERINSURED MOTORISTS 02 $ 100,000 . INCLUDED
I ,,: H Y SIC A L DAM AGE (ACTUAL CASH VALUE OR COST OF REPAIR, WHICHEVER
IS LESS, MINUS THE DEDUCTIBLE, FOR EACH COVERED AUTO.).
COMPREHENSIVE 07 SEE ITEM THREE . 346.00
FOR DED. FOR ALL LOSS .
EXCEPT FIRE OR LIGHTNING .
COLLISION 07 SEE SCHEDULE FOR DED. . 441 . 00
.
PREMIUM FOR ATTACHED ITEMS 4, 5, AND/OR 6 . 142.00
--_._--~~-~------_..__._._._._-_.~---~._._~_.__._._---._---------~
ESTIMATED TOTAL PpLICY PREMIUM .$ 2,439.00
--_._._-_._._._._-_._._~._._-----_._-_..__._._.__._-~-----.---------
.- - - - - - - - - - - - .- - ~ - - - - - - - ~ - - - - - - - - - - - - - - - -
FORMS APPLICABLE:
CA700ZA(1Z-93) CA7001A(1Z-93) CA7007(1Z-93)
CAGOO" (12.-93) C A02Z0 (5-9L~) cA215Z(9-9L~)
CA2018(1Z-93) C AZ030 ( 12..-93) CA7223(12-93)
CA 7225 ( '12~93) CA9933( '12-93) ILO-180(6-9S)
ILOO21(11-94) IL0167(7-9Z) cA7201(12~93)
- ~ ~ - - - - - - .- ~ - - - - - ~ ~ - - - - - - ~ ~ - - - ~ - - ~ - - - - - -
t
INCLUDES COPYRIGHTED MATERIAL OF INSURANCE SERVICES OFFICE, INC.
WITH ITS PERMISSION.
DATE OF ISSUE OS/Z2/97 (BF'P)
c: () R rJl (- 11 7nnn J1 .. r\ 1 ?"-O~ n<=;/10/07 nn? f)1( 'It'] '177~ 9.801
" EM C I'" 'JranCe CO'lupanies
/'tMP!,:.Q..:u;,aS MUTUAL CASUALTY COrIJPAr~Y PIHOR POLICY: 1D1-1?-73
G E ~J E R A L L I A B I LIT Y [) E C L A RAT ION S
*------------------------*
I ,.LICY PERIOD: FRO ~1 06/0 -1/97 TO 06/0'1/98 * POLICY NUMBER I<:
* 1 D 1- 17 - 7 3---98 I<:
*------------------------1<:
N A ~1 E D I ~J S U H E D : PRO Due E r~:
-~ ~ -~~ ..- - - .~ ~ - ~ ~- ~_. ~.. .- - - - -- - - -. - - -- .- ~ ,~ ,.~ ~ ~ - ~ - - - ~ - - ~
BRIDGER CANYON VOLUNTEER WESTERN STATES INS. AGENCY, INC
FIRE DEPT.
140 EAST MAIN
8081 BRIDGER CANYON RD. PO BOX 430
BOZEMAN, MT.
BOZEMAN, MT. 597710430
59715 AGENT NO: AP-7350-4
DIRECT BILL
- - ~ - - - - - - - - - - - - - - - - - - - - - - - - - ~ - - - - ,- - - - - -
INSURED IS: FIRE DEPT. BUSINESS DESC: FIRE DEPT.
I - - - - - - - - - -- - - - - - - - - - ~ - - - - - - - - - - - - - - - - - - -
L.IMITS OF HJSURANCE
GENERAL AGGREGATE LIMIT (OTHER THAN PRODUCTS / COMPL OPS) .$ 2,000,000
PHODUCTS/COMPLETED OPERATIONS AGGREGATE LIMIT .$ 2,000,000
PERSONAL AND lOR ADVERTISING INJURY LIMIT .$ 1,000,000
EACH OCCURRENCE LIMIT .$ 1,000,000
FIRE DAMAGE LIMIT (ANY or~E FIRE) .$ 100,000
MEDICAL EXPENSE LIMIT (ANY ONE PERSON) .$ 5,000
I i ---------------.---------------------------------'-----------------------------
C 0 V ERA G E S PRO V IDE D PRE M I U M
---.---.--.---.-.------.------.-----.-.-.----.--- - - ._._._--_._~~~--
OTHER THAN PRODUCTS/COMPLETED OPERATIONS .$ 153.00
_.._._-_._._.~-~--_.~-~----~---_._._.._._._-_._-,_._.-._._.~._.~--_..__._._-~..__._----
TOTAL ESTIMATED POLIty PREMIUM .$ 153.00
~ ~ -.- -.--- --- ..~~- - --.-- -~.._---- -~.~- -~ _.~.._._.- ~ ,.- .-----.- --_.~ ..~.- .-..- .-..-.- ---~---
.__.~__ __ _.~.~. _.~. __ __.,~..~. __. ._.___._ _. ~.._.~, _, ._. ~._ ~._. ,_. _._. __. _._. _. _. _. - _.. ._. ~'Y' ~.. _, __ _o.~. ,~., _.~. _., __~. ~_. _._. _.__ _n~. ...._~.~.~. ~.~. _.~.,~ ~ _. __~.. ~ _ ~ --
SEE ATTACHED SCHEDULE FOR LOCATION
OF ALL PREMISES OWNED, RENTED OR OCCUPIED~
._------_._-_._~._-_.~_._._..._._._._.__.-._-_._------.__._._._.,_._--,._._-_._._._._._._-~~~--_.__._._._-_.--------_.~----
FORMS APPLICABLE:
CG7001A(1-86) CG7003(3-96) CGOO01(1-96)
CG2 '147 ( '10-,,93) CG2'150(9-89) CG2256 ('1 ~96)
CG2021(1~96) C(;7128(8--88) CG7'129(8-88)
I L 002 .1 ( -11 - 9 L~ ) IL0243(6-89) ILO -167 (7~92)
IL7039(11~93) CG8057(1-96)
i
DATE OF ISSUE: 05/22/97 BPP
FORrlJ CG7000f\ ED.O-l'-86 05/-19/97 002 DK 1D11T73 9801
"".........
'-i I . --
.
, - , I
~ CONTINENTAL WESTERN INSURANCE COMPANY
~ 11201 Douglas, Box 1594 Des Moines, IA 50306
COMMERCIAL GENERAL LIABILITY
RENEWAL DECLARATION
~
pOLICY NO. K008920 REFERENCE NO. 03-9000417-7/000
pREV POLICY NO KD08920 RENEWAL OF 03-9000417-6
NAMED INSURED AND MAILING ADDRESS AGENCY AND MAILING ADDRESS 01158251
R.A.E. VOLUNTEER FIRE CO.
C/O MIKE HOEY T J WOOD - FIRE PAK
pO BOX 4401 P.O. BOX 1546
BuZEMAN, MT 59772 LIBBY, MT 59923
poll CY PER 1 00: From 10/01/97 to 10/01/98 12:01 A.M. AT THE INSURED'S MAILING ADDRESS
THE NAMED INSURED IS : VOLUNTEER FIRE DEPT BUSINESS DESC : VOLUNTEER FIRE DEPT
LIMITS OF INSURANCE
GENERAL AGGREGATE $ 2,000,000
PRODUCTS-COMPLETED OPERATIONS AGGREGATE $ 2,000,000
PERSONAL INJURY & ADVERTISING INJURY $ 1,000,000
EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE $ 500,000 ANY ONE FIRE
d and' MEDICAL EXPENSE $ 10,000 ANY ONE PERSON
any if
LOCATION OF ALL PREMISES YOU OWN, RENT OR OCCUPY:
LOC # 1: 5400 GOOCH HILL ROAD,BOZEMAN, MONTANA
ident PMS PDTS \
I LaC CLASSIFICATION CODE PREMIUM BASIS
RATE RATE,
, I
, 1 FIRE DEPARTMENTS - VOLUNTEER 43551 AREA 3,200 47.298 INCL
I
INCLUDING PRODUCTS COMPLETED OPERATIONS
; FELLOW EMPLOYEE/FELLOW MEMBER EXCLUSION
I cw1490 (10-96)
FIREFIGHTERS' LIABILITY ,
CW1489 (10-96)
ed and MANAGEMENT LIABILITY, ERRORS & OMMISSIONS
pany if J CW1489 (10-96)
CW24CC (10-96) : MULTIPLE YEAR RATE GUARANTEE --
BEGINNING 10/01/1996 ENDING 10/01/1999
-
~sident ESTIMATED COMMERCIAL GENERAL LIABILITY PREMIUM $468
t.190 Insured's Copy
(2) (1-92) Page 1 of 2
i . --
. , ,
CONTINENTAL \ JTERN INSURANCE COMPANY
11201 Douglas, Box 1594 Des Moines, IA 50306
COMMERCIAL GENERAL LIABILITY
RENEWAL DECLARATION
~ POLICY NO. K008920 REFERENCE NO. D3-9000417-7jOOO
OLICY NO K008920 RENEWAL OF 03~9000417-6
'. ~ ;.EV P
J..
!.. NAMED INSURED AND MAILING ADDRESS
Ii' AGENCY AND MAIL LNG ADDRESS 01158251
1>'
..
11> R,A.E. VOLUNTEER FIRE CO.
t
C/O MIKE HOEY T J WOOD - FIRE PAK
.\
:;,. PO BOX 4401 P.O. BOX 1546
l ;i BOZEMAN, MT 59772 LIBBY, MT 59923,
, ~. b:-
.I
....:, FOLICY PERIOD: From 10/01/97 to 10/01/98 12:01 A.M. AT THE INSURED'S MAILING ADDRESS
THE NAMED I NSURED IS': VOLUNTEER FIRE DEPT BUSINESS DESC : VOLUNTEER FIRE DEPT
LIMITS OF INSURANCE
GENERAL AGGREGATE $ 2,OOO,OOC
PRODUCTS-COMPLETED OPERATIONS AGGREGATE $ 2,OOO,OOC'
PERSONAL INJURY & ADVERTISING INJURY $ 1,000,000
EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE $ 500,000 ANY ONE FIRE
and' MEDICAL EXPENSE $ 10,000 ANY ONE PERSON
ny Ii
LOCATION OF ALL PREMISES YOU OWN, RENT OR OCCUPY:
LOC # 1: 5400 GOOCH HILL ROAD,BOZEMAN, MONTANA
denl I PMS PDTS
LOC CLASSIFICATION CODE PREM":-JM BASIS RATE RATE
I 1 FIRE DEPARTMENTS - VOLUNTEER 43551 AREA 3,200 47.298
i INCL
i INCLUDING PRODUCTS COMPLETED OPERATIONS
i FELLOW EMPLOYEE/FELLOW MEMBER EXCLUSION
,
\ CW1490 (10-96)
i FIREFIGHTERS' LIABILITY
CW1489 (10-96)
and MANAGEMENT LIABILITY, ERRORS & OMMISSIONS
ny if CW1489 (10-96)
I CW2400 (10-96) : MULTIPLE YEAR RATE GUARANTEE
BEGINNING 10/01/1996 ENDING 10/01/1999
en! ESTIMATED COMMERCIAL GENERAL LIABILITY PREMIUM $468
C11190(2) (1-92) Insured's Copy
Page 1 of 2
AIJrI.""
I . . I
.
GALLATIN COUNTY FIRE PROTECTION MUTUAL AID AGREEMENT
SIGNATURE PAGE
~ ?OAJuJ A L ;2 (Ie:; --:2 I( A I I-\'~f: 0 ,'s '\.
Organization ----6
I:ha/ I' rn .4-1'1
~~H'4c~ Cj-I'1-q/)
Tltle ignature Date
~i~c'f\c\WA+fJ(> (l2J ?u/(,41 1---;' /:z & - 'D, '5 -,-
organization
5er _ atlil!M1h ~(7
Title ---" ate
~?OA d U) A +C" < (lG 1;..; ~~ -, b' -~' 1--
\-. ;c~ i ~"\-\ Ie
Organization
C " Ii E {' k ; ~ ( 9-/1-97
Title Date
organization
Title Signature Date
Organization
Title Signature Date
---...-- ..-------------- ---
I .. " EMC Ins"rance' COlnpanies
f
~ ""
EMPLOYE[~S /vIUTUAL CASUALTY COMPhl\lY PRIOF~ [-......ICy: 1..11-38-38
C01VJIVJEI~ C I A L UIVJBI~El_I_A D E C L A RAT ION S
<'iQ k------------------------k
. ..,.... POLICY PEFUOD: F f~ 0 f/l 07/0 '1/96 TO CJ7101/97 J< POLICY NUMBER .,J(
i )( 1 J 1 - 3 8 - 3 8---97 *
:
)(------------------------k
N AM:;: D INS U R E D PRO [) U C E R
- - .- - ~ - - - - - ~ - - ~ - - ~ - - - - - - - - - - - - - ~ - - - - - ~ - -
BROADWATER RURAL FIRE DIST WESTEFm STinES INS. ACJENCY, INC
I, 14.0 EAST MAIN
P.o. BOX 1 '110 PO BOX 430
GOlEMAN, MT
TOWNSEND, iVIT 591'7'10430
59644 AGENT NO: AP-T350-4
/\GENCY BILL
- .- - - - - -- - - - - - ~ - ~ - - - - - - - - - - - ~ - - - ~ - ~ - - - - - -
INSURED IS: FIRE DIST BUSINESS DESC: FIRE DIST
- - - - - - ~ - - - - - - - - - - - - - - - - - .- - - - - ~ ~ - - - .- - -
L I M I T c 0 F L I A B I L I T I'
.J
.$ 10,000 RETAINED LIIVJIT
I <1- 1,000,000 OCCURRENCE LIMIT
oJ>
'" 1,000,000 AGGREGATE LIMIT
..D
_______.~____._.___~_.___.~________.____.____._________~___~_____~____________.___w_._._.___.__._
RETROACTIVE DATE AND EXCESS EXTENDED REPORTING PERIOD:
THIS INSURANCE DOES NOT APPLY TO WRONGFUL ACTS WHICH
OCCUR BEFORE THE RETROACTIVE DATE SHOWN BELOW:
.,\ RETROACTIVE DATE: 08/21/89 LINEBACKER
':.,\, AVAILABLE EXCESS EXTENDED REPORTING PERIOD: 5 YEARS
-----_.~-.---------_._~~~--------_._-----------_._.__.~---~_._._~----.----~------------_._._--_._._--
PREMIUM COMPUTATION:
F~AT PREMIUM CHARGE $ 1,300.00 (NOT SUBJECT TO AUDIT)
_~~.._.___._._._.__.~.____~_________________M_.___.___~~
TOTAL ADVANCE PREMIUM $ 1,300.00
-----------_._._---~_._,_.~--~---~-------------
(THE ADVANCE PREMIUM IS A MINIMUM PREMIUM FOR THE POLICY TERM)
A $'100 MINIMUM POLICY PREMIUM APPLIES
IF POLICY IS CANCELLED AFTER THE EFFECTIVE DATE
._ _ __ _ _ _~ ~ ~~~ _._ _.~ __ ~ _. _____ ~~ ~_ _""_ __..~___ __ _ ~ _. ~ _~. __ ~~. __ ~ _ _ __ ___. ~_~ _ ~ _ _. ~~. ~_ ~ __ __~_ _ _ ___ __ _ ____ ~~ AU. _. _. _. __ _. n~ ~ ~~
FORMS APPLICABLE:
CU7001f\ (11/88),CU"7171 (11/88),CU7002 (10/93)1ST REP
IL7036 (05/92), IL7062(07/9Z), C u7 '115 ( 1 '1/88) ,
CU.?127(11/88) , CU7"17?(11/88), CUT195(11/88),
CU7210(01/86), CU7187(11/88), CU7320(O.1/9"1 )
I'
U...
,DATE OF ISSUE: 07/10/96 13PP
FORM CU 1000/\ ED. '1'1--88 061 '12/96 00;2 1_:< 1,J 131338 9701
.. .' EMC Ins1-""ance Companies
/ EMPLOYERS MUTUAL CASUALTY COMPANY f:lRIOR PVL,ICY: 1E1-38-3(3 "
COMMERCIAL AUTO DECLARATIONS - BUSINESS AUTO COVERAGE FORM
*------------------------*
,,<~,P 0 L ICY PER I 0 D : FrWM 07/01/96 TO 07/0 '1/97 * POLICY NUMBER A'
* 1 E 1 - 3 8 - 3 8---97 *
ITEM ONE: *------------------------*
N A M E D INS U RED : PRO D U C E R :
- - - - - - - - - - ~ - - - - ~ - - - - - ~ - - - -- - - - - - - - - - - - - -
BROADWATER RURAL FIRE DIST WESTERN STATES INS. AC;ENC Y, INC
140 EAST MAIN
P.O. BOX '1110 PO BOX 430
BOZEMAN, MT
TOWNSEND, I"IT 59771-0430
59644 AGENT: AP-7350-4
AGENCY BILL
- - ~ - - ~ - - - - - - - - - - - - - - - - ~ - - - ~ - - - - - - - - - - - -
INSURED IS: FIRE DIST BUSINESS DESC: FIF~[ DIST
- - - - - - - - - - - - - - - - - - ~ - - - - - - - - - - - - - - ~ - .- ~
ITEM TWO: SCHEDULE OF COVERAGES AND COVERED AUTOS
'AUTOS' AR~ SHOWN AS COVERED 'AUTOS' FOR A PARTICULAR COVERAGE BY THE ENTRY
OF ONE OR MORE OF THE SYMBOLS FROM THE COVERED AUTO SECTION OF THE COMMER-
CIAL AUTO COVERAGE FORM NEXT TO THE NAME OF THE COVERAGE.
i
COVEf\t~i::;ES COVERED AUTOS LIMITS/DEDUCTIBLES . PREMIUIVI
LIABII_ITY 01 $ 1,000,000 <1- 2,288.00
- ...;;,
I AUTO MEDICAL PAYMENTS oz $ 5,000 . 286.00
I UNINSURED MOTORISTS 02 $ 1,000,000 . 231.00
I UNDERINSURED MOTORISTS 02 $ '1,000,000 . INCLUDED
( :~:.>
., .,V
-, PHYSICAL DAMAGE (ACTUAL CASH VALUE OR COST OF REPAIR, WHICHEVER
IS LESS, MINUS THE DEDUCTIBLE, FOR EACH COVERED AUTO.).
COMPREHENSIVE 07 08 SEE ITEI"! THREE . 576.00
FOR DED. FOR ALL LOSS .
EXCEPT FIRE OR LIGHTNING -
COLLISION 07 08 SEE SCHEDULE FOR DED. . 990.00
.
PREMIUM FOR ATTACHED ITEMS 4, 5, AND lOR 6 - 185.00
------~~---------~-----,--~-.-------.~-~------.-~-~---
ESTIMATED TOTAL POLICY PREMIUM .$ 4,556.00
------_._~~~.__._._-----_._----_._._-------'-~--_._---~--
- - - - - - - - ~ - ~ ~ - - ,- - ~ - - ~~ - ~ - - -- - - - - - ~ - - - ~ - - - ~
FORMS APPLICABLE:
CA7002A(12/93) CA-r001AC'12/93) CA7007(12-93)
CAOO01C12-93) CA0220C5--94) CA2152(9-94) CA9903 ('12-93)
CA2018(12-93) CA2030C12-(3) CA7223(12-93) cA7225( '12-93)
CA9933(12-93) IL0021 ('1'1-94) IL0167(7-92) IL0180(6-95)
CA7201(12-93) CA9916(1Z-93)
- - ~ - - - - - - ~ - - - - - - - - - - - - - - - - - - - - - - .- - - ~ ~ - -
_.~L
INCLUDES COPYRIGHTED MATERIAL OF INSURANCE SERVICES OFFICE, Ii'J C .
WITH ITS PERMISSION.
DATE OF ISSUE 07/10/96 (8PF')
FORM CA700CA ED. 12-93 051 V.... I 96 002 u< 1 E '13!>3:3 970')
" , , EMC Ins' - 'ance COlnpanies
-
/ EMPLOYERS MurU/\L CASUALTY COMPANY F'RIOf\ POLlCY: 1D-1-38-38 ""
G ENE R A L L I A B I LIT Y D E C L A RAT ION S
~, *------------------------k
<)~Ol_ICY F'EFUO!): F- R OjVJ 07/0 -1/9<:') TO 07/0 "1/97 )( POLICY Nu~mER k"
* 1 D 1 - 3 8 - 3 8---97 *
*------------------------*
N A ~1 E D INS U R E D: PRO D U C I.: R:
- - - - ~ - ,- - - ~ - - - - ~ ~ ~ - - - - - - -- - - - - - - - - - - ~ ~ - - -
8ROADWATE~ f\URAL FIRE DI5T WESTERN STATES INS. i\GEi\/CY, INC
-140 E/\ST 11lf;.\IN
P.O. BOX -1110 PO BOX 430
BO Z c:rIJAN, 11lfT.
TOWNSEND, MT. 5977'10430
59644 AGENT NO: AP-7350-Lf-
i\GENCY BILL
- - - - - - - - - - - - - - - -- ~- ~ - - - - - - - .- ~ ~ ~ - - - - - - -- - ~ -
INSURED IS: r:IRE DI5T BUSINESS DESC: f~-IRE DIST
---~-~ -~----~ - - - -- - - ~ - - - - - .- - - ~ ~ - - - - - .- -
LIMITS OF INSURANCE
GENERAL AGGREGATE LIMIT (OTHER THAN PRODUCTS I (()rIiPL OPS) :8 2,000,,000
PRODUCTS/COMPLETED OPERATIONS AGGREGATE LIMIT :t 2,000,,000
PERSONAL AND lOR ADVERTISING INJURY LIMIT ,f' 1,000,000
""
EACH OCCURRENCE LIMIT '" 1,000,000
""
FIRE DAMAGE LIMIT ( MJ Y 0 r~ E FIRE) .$ 50,000
MEDICAL EXPENSE LIMIT (MJY ONE PERSON) :t 5,000
--,-,~,~---,..__._._~,._,----_._-,_._~-----------_._'--,--_._-~,-~,-_._.~---_._-_.__._"--"-'~-_.~'_._._'_.--,------~-
C 0 V ERA G E S PRO V IDE D F'r~ElvIIUM
-----,~,~------"---_._--~~.~~-_._----'---'-_._.__. -- ,- -- - ,- - ,- ,- -.- ~ ..., ~."
OTHER THAN PRODUCTS/COMPLETED OPERATIONS 0' 98L. _ 00
"i
~-~~._---,------,--_._-----'-_._,._--_._-_._._~----~'-----------'-'--
TOTAL ESTIMATED POLICY PREMIUM ." 9:34.00
,I;'
._~-~~-,-,-,--,-"_.~._~---_._._----_._--'-'~-'_._-_._-.-----.-.--'---.---.--
~.~~_.~_____._._._._.'_,___.____._,_,_.._.__.__._._'_.'.N_...._._._._._,_._._.____.___._.___._.___..M._._'.~,'_.__._.~.._._._._____,._._._.___,_.~_._.~___
SEE ATTACHED SCHEDULE I"OR LOCATION
OF ALL PREMISES OWNED" R E i\J TED OR OCCUPIED.
--~-,--"--~._,_._--,--"-,._'_.~._.~._.._'--'_._"--_.~_.._._------'_._-,---,-,'-'-'--'--~---'~-----_._----------,-,-~---
FORMS APPLICABLE:
u;700 1 A (01-86) CG7003(2-86) CGOOO1(10-93)
C:i2147( ""10-93) CG2150(9-89) CG7110(1-86)
CCi2256(11-85) CG2021(10-93) CC7128(8--88)
C ::17129 (8".'88) I l 00 2 'I ( 11- (4) IL0243(6-89)
L_7039 (9-89) IlO16'7(7-9;2)
';/
'" DATE OF ISSlF~: 07'/10/96 BPI=> /
FORM CG7000A EIL01-86 05/14/96 CO2 li< '1 D '1:5.'""):3', 970 -1
I . --.
.
STATE COMPENSATION INSURANCE FUND
~:~~ 5 SOUTH LAST CHANCE GULCH Coverage Declarati ons
P,O. BOX 4759
'''. FUND HELENA. MT 59604-4759
UNDERWRITING DEPARTMENT
'. '. , POLICY SERVICES 1.800-336-8968
POLICY NO. 03-1333-45-3 UNIT NO. 2
(406) 444-6440 TOO: (406) 444-5971
o This is the original Declarations and W These Declarations reflect the current coverage information assigned
rem<lins in effect until replaced. this insured and replaces all other Decl<lrations issued.
Coverage Effectlv" I Date Issu"d . l Entity Type
04/19/96 OS/24/96' LOCAL GOVT
B Claim. Mailing Addre,.:.
I
A N BROADWATER COUNTY RURAL FIRE DISTRICT
S 515 BROADWAY
S U TOWNSEND MT 59644-0000
I R
E
C 0
Addltion:llllusines. Nam". and Location.
C BROADWATER RURAL FIRE DISTRICT RADERSBURG
0 BROADWATER RURAL FIRE DISTRICT DUCK CREEK
V BROADWATER RURAL FIRE DISTRICT TOSTON
E BROADWATER RURAL FIRE DISTRICT WINSTON
BROADWATER RURAL FIRE DISTRICT TOWNSEND
R
A
G
,.
c:
S
The following cover<lges arc considered in force based on endorsements-previously returned or encloser:.
Earnings must be reported as required by State Fund. Please refer to Section B of your policy.
Mlscellan"ous Endorsem"nt.
VOLUNTEER WORKERS EFFECTIVE 04/19/96
0
P
T
I Dependent Family Memben of a Sole Proprietor, Partner or LLC Member/Manager Effective T enninated
0 NONE
N
A ,
L
C
0 Officers. Partners, or Owner. Sole Proprietor. LLC Managers or LLC Member/Manager Monthly Wage Level covered Effective Terminated
V NONE
E -
R
A
G
E
S
All Classification and Codo Schedules originally issued, and as replaced from time to time, constitute a permanent part of tho
policy and should be maintained herewith.
If you have any questions concerning the information shown on this document, please contact Policy SorvicQs at the address or
phone number shown above.
Sf.MIS CF-IOOD (Rey. 3/~~) SF.OO1
~!
r-S=fA1= STA TE COMPENSATION RURM. VOLUNTEER STAh _ 2e EfVeEJ)ATE
MUTUAL INSURANCE FUND FIREFlGllTER ENDORSEME;\T
FU,ND PO, UOx ,1759 MAY 221996
IIELENI\, :v1T 5')(,04-4759
.. UNI)[jZWIUTING DEI'AlnMENT (STATE I'U~D W;L ()i'iLYj
I POLIO' SERVICES (406) 444-6-140 SiATE FUND i"cS
POlICY
.4L N()~' - {) 3.' I 3 3 3 q 5"~ 3
ImjlOf/cmt Noi~,~;-'lli~cndOrst:J\\l'lll is 1101, applicable l? volunteer, i',lvolvcd,in air ,'.;.eartll ;IIH.J l\~.';~llt.:: J(lr tlh': ,\1()l1l;lI1i1 Dcrar[ll1cl~( o~-Trilll:-.pnrtali~n,
"" .,' ..c..:~,?1~, tcc:r ,";C['VC or ,llD,;,Illilry pr.:::ac.c nlficcrs ;XOVIJJnS serviCe 10 a locallilw Cllk,n:Cfl1~:ll :1!;.l':ICY or VOIUll(l;c:r I m::1Jghwr:-; provldlllf;.
r:.'~ ,,'~'~':; ':i~~~ ,\,t.:.p~~;:~ 10 illllllcurpor:Hcu eny ur town.
'~. ,,",. ENDORSEMENT t\CREE:vlE!,;T ELECTIN(j COVER,\GE
.. ).. FOR ENROLLED ACTIVE ME:-'1BER RLJRAL VOLUNTEER FIREFIGHTERS
(Subject to State Fund Approval)
""'.......'
lJmkr MonLlna Worker~' Compcns;nion ~nd Occupational Dise~se Acts, an elnployer IS NOT rcquired to proviJe worker:;'
compensation insurance coverage for rur~l volunteer t1ret1ghters inlheir Julies as rur,\l volunteer firelighters..
The trustees ,)t" a rur~1 rire diSlrict, a county governing body providing rural fire protection, the county commissioners or trustees
for ~ rire service arc m,IY dect cover~ge for enrolled :1I1J ~ctivc members of a rire comp~llY organized ~nd funded by n county, a
rural rire disc'ict or a fire service are;l. If covernge is e!ected, the electing employer shnll report payroll for nIl volunleer
fIrelighters feir premium and weekly benc1it purpcses b~~ed on the number of volunleer hours of eneh llrellghter tirncs the
avernge wed:ly wage divicJ:::d by 4() hours, subJect to n maximum of I 1/2 ,ilne;; Il~e aver:lge wecldy W:Ige. The maximum ,1lnOlllll
is annually reviscd and indicnted onlhc State Compens~lion Insurance Fund P:lyroll and Premium Report instructions. Inlhe
ever.t of a work related injury, compensation benclils will be based c)nlhe volunleer hour" of service performed subject to a
maximum el~cJallO the state's aver8[;e weekly wage at time of ir.jury.
Tile term "VGlullteer hours" means all Ihe time speOlt by J volunteer fireJlglller ill 111<: ,;ervice of an empluyer, includiog butllot
limited to tr:J::ling lime, re~poilSe time and lime; spent ~lllhe employer's premises. :\n :JcluaI account of hours must be
maintained, An estimate of volunteer hours will not be; an appropriate representation of the actual voluntecr hours of service
performed. :\ voiu:\teer firefighter who receives workers' comper.salion cover;lge under the Workers' Clmpensation nnd
Ol;cuqion~l: Disease Acts may not receive disability bcnc1IIS under Title 19, ch~lptcr 17.
/;; Nu~nber of Enrolled 8.: Active !'vlember Rur:J1 Volt;nteer Firefighters
We undcrsl:Jnd the report:Jblc wage~ for all enrolled and active member rur~ll volunteer firefighlers mw;t ile reported in
classi[icatio:1 code #7704 on the Payroll & Prcmium Reports furnished by the SlJ.te Fund at the end of each re[Jorting period.
TIle name~ :J:ld social security numbers of all volunteers muSl be included. We nlu~l submit ;j signed reljuest to discontinue
coverage. Cuverage will cC:J~e the day the SUte Fund recc.ives the request. Otherwise, cove~ngcwill autom'-llically continue L:nti!
the policy is ;::lI1ccllcd.
-6.'//,cf /7' t
S gnature of dl:Jirpcrsor )f thc bO;lr of lrusces of the. fire company; or / D:Jlc
Sign:Ilure of~hairpersl n of a couoty ~~overning beard; or
Signature of :l COUnly eOlllmissioner; or
Signature of ~hairperson or the board of trustees of a rural lire district. 'DD' If"/' ......."',\'I'r.cS
L' Li.~J \\ ~J.;:"'i\ ~'IV~
'1 a ~ C,\-:" '. ..,-1"1\'
(/" Ih r rrl4-rl c. ,i i\.
Title A09~
\.4~V '/k 1.J \,
. ." ~ ~
Mail the con,pleled cndorscmcnt ~o the State Fund, P.O. Sex 4759, HelcOl<l, [\1T 5<)(,04-4759. i\ complete rostcr or ;111 e::~cl!cd
'.,..Il.....
& active me::lber rur,1I volunleer firelighters must <lccompany the completed endorscment. A copy of the resolution or minute's
whereinlhe trustees, county commissiooers to :Ipproving body elects cover;lge for the enrolled :Ind active member rur:II
l1refighlers lr,~st accopany the compJclcd cndorsement.
LOWER I)ORTIClN TO BE COMPI.ETED rlY ST.\Tl: 1;'U:'0D 01"1- y
V
This Endors(~~n[;lll is hereby: 4< ).~AP[JrO'ied _Nol Approved
Reason not :l~proved: '11\ .1/L<<_/v,-CJ----u ~ )
Authorized Signature E1Teuive O:Ite f\~ n ;J . ,V\.,./
i \' (r ?,'!J I ....-
0-,
~~/JI)_ CERTIFICATEO~ ",lABiliTY INSURANC iR CD DATE (MMlDOIYY)
. . '. 'ANBA-3 09/24/97
PR?DUCER THIS CERTIFICATE IS ISSUED AS A MAITER OF INFORMATION
F1.rst West lIne. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1 West Ma~n HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO Box A ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
Bozeman NT 59771 f--- COMPANIES ~~ORDI~~ C::OVERA~~__,.___ .
Kevin Winegardner I CIe I COMPANY .
_... 406-587-5111 ~... 496-586-2_757 ~A conu""Dtd.........=_ I""uran",, _
IN$URED COMPANY
B
-. - ..~,~.. ~'.~-~~~..
Manhattan Rural Fire D~st.rict. . COMPANY
Roland Liqtenberq I C .._ '__________...
PO Box 125 : COMPANY
Manhattan NT 59741 I 0
COVERAGES
THIS IS TO CERTIFY THAT THE POUClES 4>F INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREO NAAfED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMeNT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERT1ACATE 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 PDUClES. LMTS SHOWN MAY HAVE BEEN REDUCED BY PAlO ClAIMS.
co r~-- TYPE OF INS~RAN~E POLICY NUMBER POllC~- EFFECT1VE I PO~~ EXPIRATION I ------ l.'M'TII
L TR I DATI! (MMlDDIYY) DATE (MMIDOtYY)
~~Al.l.IASlUTY I GENERAL AGGREGATE I $ 10 I 000 I 000
A I.XiC~MERCIALGENERALlIABIl.ITY K015720 11/26/96, 12/01/97 ,?ROOUCTS-COMP'.O PAG....~.... $1D~OOO,O_<<?Q
, CLAIMS MADE ~ OCCUR PERSONAL & ADVI~~URY $ 2 I 000 , 000
..~ OWNER'S & CONTRACTOR'S PROT .eACH OCCURRENCE .. .I $_..2,000 I 009"""
L- I _._ FIRE DAMAGE (A~~ one fire) ~ 500 . 000
-j MED EXP (Anyone pel'5On) i $ 10.000
~oMO"'I..InlA8Il.ITY COMBJNED SINGLE LIMIT I $ 2 I 000 I 000
A ~ ANY AUTO K015721 11/26/96 12/01/97 i ___
f-j ALL OWNED AUTOS BODILY INJURY I $
HJ SCHEDULE[) AUTOS I (Per pen;on) ~._
. HIRED AUTOS , BODilY INJURY I $
(Per accident)
1_ ~ NON-DWNED AUTOS I
~~ I PROPERTY DAMAGE I $
1 ,I
'l GARAGEllA8ILIlY i AUTOONlY.EAACCIDENT i $_~_
i - l ANY AUTO On:.E':~ THAN AUTO ONLY I ._ ,,_ .
Ii EACH ACCIDENT I $
I ' ,
,'~--' AGGREGATE $
I
, I
1_ E)l;C. ESS UABlLITY I EACH OCCURRENCE , $ ______
C: UMBRELLA FORM , I AGGREGATE I S
I I OTHER THAN UMBRELLA FORM I I I $
, we STATU. I OTH-
WORKERS COMPENSATION AND TORY LIMITS I ER_ _"~,,__
EMPl.OYERS' l.IABIL.1TY El. EACH ACCIDENT $
-.. .~, ----- ,-.--.-...
THE PROPRIETOR! INCL EL DISEASE - POLIcY LIMIT $
PARTNERSlEXECUTIVE El. DISEASE. EA EMPLOYEE $
OFFICERS ARE: EXCL
i~~ I
!
DESCRIPTION OF OPEItA TIOHSll.OCATIONSNEHICl.ESlsPECIAl. ITEMS
RE: Mutual Aid aqreement applies to this insured and :is covered under the
policy numDer named above. ;
CERTIFICATE HOLDER ... CANCeLLATION
MANIlA - 3 SHOULD ANY OF THE /IBOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THl!l'IeOf, THE ISSUING COMPANY WILL ENDEAVOR TO MAIl.
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Manha ttan Rural Fi:re District SUCH NOTICE SHAl.l..IMPOSE NO 0811G.ATlON OR l.lABlllTY
Roland Of' ANY KINO UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES_
PO Box 125
Manha t tan NT 59741 AUTHORIZED REPRESENTATIVE
ltevin W~neqardner, CI
ACORD 2S-S (1JH)
, 10/15/1'3'37 {J4: 42,' 4062854145 THREE VALLEVS IHSUR . PAGE' 01
PUBliC ENTITY GENER.I\L LIABILITY INSURANCE POLICY ~
Insurer: TWIN cITY FIRE IN;1JAANCE COMPANY
1 COI"IJEGE PARK, 8110 PURDUE ROAD
INDIANAPOLIS, rND 46268-0930
OECLARA TrONS POLICY NO. 41 CES QH0630
Items Previous pOif(; ;-]IJo. J [ MANHATTAN, TOHN Of'
III CES etL 724 S
P.O. BOX 96
1" Named Insured and Mailing Adclres~; .----... MANHATTAN, MT 597111
06/01/97 06/01/98
2. Policy Period ,------- ~, .. Inception ~._.~.-- bplratioll Oat"
12:01 a.m. Standard Time at the vddn ,s:, of
the Named Insured as stated hemin.
Producer's Name and Address Code No.
PENCO 450126
663 VALLE VISTA AVENUE
P.O. BOX 35500-555
BILLINGS, M'l' 59:1,07
3. This policy is not subject to auc'it Ul t11!SS an Audit Period is herelfl stated: o Policy Period o Semi-Annually
4. Deposit Premium $ ~,O.jO. o Quarterly o Monthly
-,-
Minimum Retained Premiumf\!C>T ,!"pI'-'LI CABLE. not subject to adjustment in the evont of cancellation by you,
,-~ ,--
5. Limits of liability
The Limits of Liability, subject to irll thll terms of this policy that apply, are:
Bodily Injury an(j Property Damaqe U nt- Each Occurrence c 1,000,000.
.,
Personallni~Jry and Advertising In!ury Lirnlt - each Offense _~~_LLq.O O-,J>~_~._~~,..~
Employee Benefits Injury Limit. E;]ch Offense :~ 1,000,000.
Fire, Lightning or Explosion Dam;lge lImIt - Any One Fire, Lightning or Explosion ~~$ 500, 000 _ ---~~-
Medical Payments Coverage limit - ,\ny One Person S 10,000. . .-.
. :\rIY One Accident $- 10,000,
- .\\Igregate $ 100,OOO~~
General Aggregate Limit (Other than I 'rl)ducts-Cornplotccl Operations; Fire. .- ...,.
Lightning or Explosion Damug0: '1l\d Medicol Pt.lyrnents Coverage) $ I, 000 L_Q_O 0-=---__
Products-Completed Operations ,(\ggl eqate Limit $ 1,O~?-,-OOO.
-','-"-'~. - '-....1.",......--
6, Classifications, if ~ny:
REFER 'f0 SCHEDULE ATTACHE:D. :-ORM GN 9907
- PUBI,:rC l~Nl\I'tY
7. Business Description:
8. Fo(m Numbers of Policy provisioma nd Enci'O'rSements forming a part of this policy:
SEE LISTING OF POLICY PROVI.:)IOt I~, AND ENDORSeMENTS fORMING A PART OF THE POLICY ATISSUE. I
---' - - ~ ,............ .
TI,i, policy will not be valid unlcss C"Un! ''''good by all' duly "uthocr,ed '"pmson'.liv, ( / )/:/:4: /;" ~
ALM 1. 05/07/97 countcr"ign;~ n/~ ~L.. .-
Form GN 0001 14 (ED. 03/93) Pri'lted ir~ U.S.A. (NS) Aurhorized Representative
1
C opyrigtlt HiH1ford f-::irc Insumnce Cornp~H1Y. 1993
~ " ''-,
GALLATIN COUNTY FIRE PROTECTION MUTUAL AID AGREEMENT
SIGNATURE PAGE
CY%~<X~~~'I~~..~ G-K)~~,
organlzatlon "-
c:h~~~-, f{~ ~~~~\o 1(ml"')
Tltle 19nature \ \ ~
C. ~.r:~'f.. (, ,/.),_ t' Z(.'v!,.".' 1 .:--;~., ~~--(~, '--.1 < 1"- c--r' ,~,....) .~'L~..'.(
organization '
, ~ I
,~ I /'/.}.,,) L-' ,/ C;" ':..1 - ......'/
,. :)..~~___( //, ~~VI_'/ --~_.-,. .' /~C"_,__< ,-<,_--? ~ ../ '.'.c,_,,_,'.A ( - /, '/ 7
Title SI?nature / Date
,.- I // _ j/''';' /[/ ~, (~,} , .. d ?---L..J
:' &'~~:1 ./...---./~2......' r..-:1"".'",,_ ..I; "1 .---(.... ../~~..'-I._.,~_"-{.!--<. - <.L--..--
brganization/,__ ..,~ r)
/'1 ~//'/') ,,/ ,- ~
' " ,7, '
".':> / ~(" . ///. ," C' . i /-
li.L,:!. ~-'C:"I ;f>'?','""--('..--y'---- ,/ 0::t/gy " .~ ~7z..qr>J.-.- )2 )'/ f /7
Tl tle'7" i1 A-,G..k-' Slgnature:./ Da e
.;Lt>----<:' .. /'
:= \ -, .- ~ -, ........ -}'(', '\--' 1',( ~< r \, ; ___ p..\ r ;Lc.\
Organization
"'" ~09 ~ &
--------.... 'I .... _ (' .-'" /~ ---- ~ -, ---~
. I, {'./ "l (' ~ r \ . \ \('/'" .,.-- (, - / '..~"-' ,
.~:-:' :.:.., ,'" '~/, "~" . ". ., \ ---- ..~ L.- c- .1 !
Title Signature Date
Organization
Title signature Date
i .
THIS ENDORSEMENT CHANGt::S THE POLICY. PLEASE READ IT \"AREFULL Y.
I L 01 80 12 94
MONTANA CHANGES-CONCEALMENT" MISREPRESENTATION OR FRAUD
This endorsement Illodifies insurance provided under the following:
BOILER AND MACHINERY COVERAGE PART
BUSINESSOWNERS POLICY
COMMERCIAL AUTO COVERAGE PART
COMMERCIAL INLAND MARINE COVERAGE PART
COMMERCIAL PROPERTY COVERAGE PART
FARM COVERAGE PART -FARM PROPERTY COVERAGE FORM
FARM COVERAGE PART -MOBILE AGRICULTURAL MACHINERY AND EQUIPMENT COVERAGE FORM
FARM COVERAGE PART -LIVESTOCK COVERAGE FORM
The CONCEALMENT, MISREPRESENTATION OR FRAUD whether before or after the loss ("loss") and relating to
Condition is replaced by the following: coverage of the loss ("loss") under this policy,
CONCEALMENT, MISREPRESENTATION OR FRAUD We will not pay for any loss ("loss") or damage in any case
We will not pay for any loss ("loss") or damage in a case of: if:
1. Concealment or misrepresentation of a material fact;
1. Concealment or misrepresentation of a material fact; or
or 2. Fraud
2. Fraud is committed by you or any other insured ("insured") in
committed by you or any other insured ("insured"), the application for this policy,
JOHN M. '11/ ALLACE AGE>iC'
1700 W. KOCh Suite 10
Bozeman. MT c r-.. ~ ~,.-
,.) .J i I.,j
(4061 587-8998
~ '1V1~1I1 P.j/ A 1'''1'/, ~r
OAUTHENTlCO Copyriijht, Irl<;l.Jrance Services Office, Inc., 1<)<)4 GU 475
A\'II~AN;:;I':I'~:""~':}\\'j.": "'I Copyrighl, ISO CommerCial Risk Service'; Inc., 1994 (12-94)
I
BUSINESS D TRUCK INSURANCE EXCHANGE , ,liD-CENTURY INSURANCE COMPANY [XJ FAR ilNSURANCEEXCHANGE
,_
AUTO D
llECLARATIONS
LXJ POLICY MEMBERS OF FARMERS INSURANCE GROUP OF COMPANIES
[] COVERAGE PART HOME OFFICE: 4680 WILSHIRE BLVD., LOS ANGELES, CALIFORNIA 90010 R
ITEM ONE
NAMED FIRE SERVICE AREA #6
INSURED Prematic Acc't No. Prod. Count
MAILING 12454 CLARKSTON 70-11-S41 Ont;RS-?7-~~
ADDRESS Agent Policy Number
THREE FORKS MT 59752
o Partnership Type of
The named insured is an individual o Corp. Business VOL FIRE DEPT
unless otherwise stated: o Joint Venture o Organization (other than Partnership or joint venture)
Policy Period from 03/10/96 (not prior to time applied for) to 03/10/97 12:01 AM Standard Time
If this policy replaces other coverages that end at noon standard time on the same day this policy begins, this policy will not take effect until the othe
coverage ends. This policy will continue for successive polic~ periods as follows: If we elect to continue this insurance, we will renew this policy if you pa
the required renewal premium for each successive policy period su ject to our premiums, rules and forms then in effect.
ITEM TWO SCHEDULE OF COVERAGES AND COVERED AUTOS
*This poliV p'rovides only those coverages where a cha~e is shown in the premium column below. Each of these coverages will apply only to those "autos" show
as covere 'autos". "Autos" are shown as covered "au os" for a particular coverage by the entry of one or more of the symbols from the COVERED AUTO Sectio
of the Business Auto Coverage Form next to the name of the coverage.
* COVERED AUTOS LIMIT
THE MOST WE WILL PAY FOR PREMIUM
COVERAGES ANY ONE ACCIDENT OR LOSS
(LIMITS SHOWN IN THOUSANDS)
LIABILITY 7 $ 1000 554.00
PERSONAL INJURY PROTECTION SEPARATELY STATED IN EACH PIP ENDORSEMENT
(or equivalent No-Fault Coveraqe)
ADDED PERSONAL INJURY PROTECTION SEPARATELY STATED IN EACH ADDED PIP ENDORSEMENT
(or equivalent added no-fault cov.)
PROPERTY PROTECTION INSURANCE SEPARATEL Y STATED IN THE P.P.L ENDORSEMENT MINUS
(Michigan only) $ DEDUCTIBLE FOR EACH ACCIDENT
AUTO MEDICAL PAYMENTS $ SEE SCHEDULE
UNINSURED MOTORIST 7 $ 1000 36.00
UNINSUREIJ MOTORIST $
PROPERTY DAMAGE
UNDERINSURED MOTORISTS (When not $
incl. in Uninsured Motorists Coverage)
PHYSICAL DAMAGE Actual Cash Value or Cost of Repair, whichever is
COMPREHENSIVE COVERAGE less minus $ SEE SCHEDULE Oed. for Each Covered
Auto. But no Deductible Afcplies to Loss Caused by Fire or
Lightning. See Item Four or hired or borrowed "autos".
PHYSICAL DAMAGE SPECIFIED Actual Cash Value or Cost of Repair, whichever is
CAUSES OF LOSS COVERAGE Less Minus $25 Oed. for Each Covered Auto for loss
Caused by Mischief or Vandalism. See Item Four for hired
or borrowed" Autos".
PHYSICAL DAMAGE Actual Cash Value or Cost of Repair whichever is
COLLISION COVERAGE less minus $ Ded. for Each Covered
Auto. See item four for hired or borrowed" Autos".
PHYSICAL DAMAGE
TOWING AND LABOR $ for each disablement of a private passenger
"auto." (ACTUAL LIMIT)
I PREMIUM FOR ENDORSEMENTS
I ESTIMATED TOTAL PREMIUM 590.00
u\JHr.j IV1. ' ~ - ",-.. .........
'J I I~\......... ......... 1-..... ',~. =- I......... -",;'':''1 ',Iv ( ..
i700 w. KOCh Suite 10 ..:~
8oz"?man. ~/1T ~ :~ "71 c::
......J --' I ;....;'
56.~190 3RO WITION 12-91 i 4(~'~i ~ ::~ 7 _ '~ (-\ I-.~ ,_/ E.92 PAGE 1 OF 3
i .
0 5-27-33
BUSINESS AUTO DECLARATIONS (CONTINUED) Policy Number
ITEM FOUR
SCHEDULE OF HIRED OR BORROWED COVERED AUTO COVERAGE AND PREMIUMS
LIABILITY COVERAGE RATING BASIS, COST OF HIRE
STATE ESTIMATED COST OF HIRE RATE PER EACH $100 FACTOR~lf liab. PREMIUM
FOR EACH STATE COST OF HIRE COV. IS RIMARY
PREMIUM
Cost of hire means the total amount you incur for the hire of "autos" you don't own(not including "autos" you borrow or rent from your employees or their famii
member.;), Cost of hire does not include charges for services performed by motor carrier.; of property or passenger.;.
PHYSICAL DAMAGE COVERAGE
LIMIT OF INSURANCE ESTIMATED RATES PER PREMIUM
COVERAGES THE MOST WE WILL PAY ANNUAL EACH $100
DEDUCTIBLE COST OF HIRE COST OF HIRE
ACTUAL CASH VALUE, COST OF REPAIRS OR
$ WHICHEVER IS LESS MINUS
CGMPREHENSIVE $ OED. FOR EACH COVERED AUTO.
BUT NO DEDUCTIBLE APPLIES TO LOSS CAUSED BY
FIRE OR LIGHTNING.
ACTUAL CASH VALUE, COST OF REPAIRS OR
SPECIFIED $ WHICHEVER IS LESS MINUS
CAUSES OF LOSS $25 DED. FOR EACH COVERED AUTO FOR LOSS CAUSED
BY MISCHIEF OR VANDALISM.
ACTUAL CASH VALUE. COST OF REPAIRS OR
COLLISION $ WHICHEVER IS LESS MINUS
$ DED. FOR EACH COVERED AUTO
PREMIUM
ITEM FIVE
SCHEDULE FOR NON-OWNERSHIP LIABILITY
NAMED INSURED'S BUSINESS NUMBER PREMIUM
other tha n a $
Social Service A enc $
Social Service Agency $
$
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE
THE INSURANCE AS STATED IN THIS POLICY.
Premium shown is payable:$ 590.00 at inception.
ENDORSEMENTS ATTACHE!) TO THiS POLlCY: iL 00 21-Broad form Nuclesr E;-:clusion(Not app!icable in New York)
CAOO010692 CA02200594 CA20180187 CA21520994 E0207-ED1 ILOO030689 ILOO171185
ILOO211185 IL01670792 IL01800695
LOSS PAYEE
COUNTERSIGNED 2-)~ BY i/~
(Date)
" "~;~::C JOHN M. WALLACE AGENCY
~ ."'.. . .,. 1700 W. Kocn Suite 10
).J ~r
'\;.-" \::"'1 Bozeman. MT 59715
\
(406J 587-8998
56-5190 3RD EDITION 12-91 E-92 PAGE 3 OF 3
--~.....
To Our Customer: Safety and Loss Prevention in the work place is of major importance to both you the insured, and us the
insurer. The following is a 5t-MPLE Self-Inspection Checklist to assist you in this :mportant matter It is strictly a base form for
your internal use. The Checklist is general in nature and some questions may not apply to your business. You may wish to
make your own Checklist form so as to be more oriented and more specific toward your particular business. To be effective, it is
recommended that a Check Self-Inspection be conducted montnly.
I A. LIFE SAFETY:
I
Y N 1. Are all exits unlocked. free of any obstructions, and adequately marked?
Y N 2, Is emergency lighting, where required, operational?
Y N 3, Are illuminated exit signs operational?
B. HOUSEKEEPING:
Y N 1. Are all aisles and walkways free of any type of debris and/or storage':'
Y N 2. Is all trash picked up and removed from the facility each day?
Y N 3. Is all stock properly stored in assigned areas?
Y N 4. Is any combustible material stored around any gas-fired units?
Y N 5. Is smoking restricted to only designated safe areas?
C. ELECTRICAL:
Y N 1, Are all appliances and/or machine power cords free of physical damage?
Y N 2, Are all ground prongs properly in place on plugs?
Y N 3. Are proper protective covers in place on all electric junction boxes?
y N 4. Are any power cords stretched across aisles or walkways? >-
y N 5, Any improper use of extension cords in place of permanent wiring? ()
y N 6. Is ventilation adequate for the hazard involved? 20
y N 7. Are pressurized cylinders properly stored and secured? llJ'-lf)
(J .-
D. HAZARDOUS MATERIALS: <((1)1'-0.:>
::::. CI (J)
llJ=tf)(J)
y N 1. Are all hazardous materials properly labeled and stored? O(j) OJ
y N 2. Are flammable liquids properly stored in "Approved" safety containers? <{Cl-I
Y N 3. Are flammable liquids properly stored in flammable liquid cabinets? .-JU~~
y N 4. Is only a one-day working supply outside of cabinet at anyone time? --10,U)
y N 5, Are all hazardous materials storage areas properly identified? <t::-GC
m_
y N 6. Is ventilation adequate for the hazard involved? >~~~
Y N 7. Are pressurized cylinders properly stored and secured?
'0 N","
E. MACHINE GUARDING: ~ 0-
0(1)
y N 1. Are all points of operation adequately guarded? Zl"-
:c."-
y N 2. Are all machine drive points adequately guarded? 0
.....,
F, MATERIAL HANDLING:
y N 1. Are proper lifting techniques used by employees?
y N 2. Are carts and/or hand trucks available for moving heavier loads? ,
y N 3. If forklifts are used, are employees adequately trained in their use?
G. PERSONAL PROTECTIVE EQUIPMENT:
y N 1. Do employees wear protective equipment where required?
Y N 2, Is the protective equipment used adequately for situation encountered?
".'.. ,
H. FIRE PROTECTION:
-,
Y N 1. Is there an adequate number of fire extinguishers for the hazard protection?
Y N 2. Are fire extinguishers serviced annually?
Y N 3. Is all fire protection equipment free of obstructions and readily available?
Y N 4. Are employees trained in proper use of fire protection equipment in site?
y N 5. Is the sprinkler system flow-tested and inspected annually?
If you have any questions or are in need of assistance in establishing or improving your Loss Prevention Program, please
contact the Farmers Commercial ,n::.urancE: GI ou~, l.u::.::. Conti oi ::'t:p",rum:nl ell \2CO) 2:'6-0046. l"t: joor.. f(JIWi;>1 () .u ::'t:(V'('Sj /Ul..
and the needs of your company.
\ I .
.
GALLATIN COUNTY FIRE PROTECTION MUTUAL AID AGREEMENT
SIGNATURE PAGE
S::6vV?. 'tvJ( )(1-(.-1- K f\)~
.
Organization
lh\-e c\,/\oIA ~'\a(;\ Co Vlr)P(/ (j1-c 6-97
Title Signature Date
Organization
Title Signature Date
organization
Title Signature Date
Organization
Title Signature Date
Organization
Title Signature Date
---------------- --------
I /. . <..; insurance cOlllpallH:~S
/ '\ / '. BUS 'I N ~.i,L '-,c Y Sillf?-D-1- "-
)/ c! ,J's
"'/pLICY- PERIOD, .
-j~OM: SEE SECTION DEC~~RATIONS i~~jl*-------c---~~~----------*"
( 12:01 A.M. STANDARD TIME *. ,..~~t}M,EJ,~R" .. *
/. AT YOUR MAILING ADDRESS SHOWN BELOW * 1X~3~~'~~3- 9";;~98 .,
(UNLESS CHANGED ON THE SECTION DECLARATIONS) *--,.:.:.~.;.;;.;,:....:.:.::...:.:.::~~I.:=.~-__~~----~
N A M E 0 INS U RED : PRO 0 U C E R :
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
.,.................~,.... '~I.n'....':'\i."" ~ ,.". 'j,. '..
SOURDOUGH RtlRAL't'f''IREf1;DISTIHCT'1' WESTERN STATES INS. AGENCY, INC
4541 S 3RDSTREET"'" '-,,"" ,'. - 140 EAST MAIN ST
BOZEMAN, MT 59715 PO BOX 430 ~
BOZEMAN, MT 59771-04~<:)1r'
AGENT rA~~"t
AGENT'~HONE: (406)586-3351
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
INSURED IS: FIRE DIST BUSINESS DESC: FIRE DIST
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
IN RETURN FOR TH~ PAYMENT OF THE PREMIUM, AND. SUBJECT TO AL~ THE TERMS OF, :
THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS
POLICY.. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A C,',::;:
PREMIUM IS - INDICATED~ THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. THE 'Ii':.
COMPANY AFFORDING COVERAGE IS DESIGNATED BY THE NAME IN THEDECLARATIONS~;r!-
OR INFORMATION PAGE FOR EACH SECTION OF THE POLICY.
- - - - - "::~,:_:;;-':;;.!.j: - ~..;- - - - -.;.;,. ----.- - -,=-')'-"- -"- - - - - - - -.... --
,.... .~~ ....... '...... .. ;~' - . ~ ." ., .....' . .," .j ',""
,; S E C T I;-O,"'N' ~ c. C 0 V"E R A "G"E -',\..,':;, :- P;RE M I U M ::e(~-
-~7-:------"~,~~- '.',,'. ~,.- --------------------- ~il;'. - -------------
1'''-< '<PROPERTY'" . ,.,{.., ,"" '$ 352 00'( ~!'
. .' ...,. . .. ,,~ .........,~,... _," ~ .. ."1 (4..1
2 -"". LIABILITY-' .,-';. ,;:",:' 415.00 '"
3' " ''''. "CRIME -- '~", .~; ::,-,..,..~ 'NOCOVERAGE"'er:~i-' ''';
. 4, ___. INLAND MARINE . 947.00
S 5 ;,,"" ':;". AUTOMOBILE' " ~ . ^ ::" 3,433.00.'TIES
6 ~'. " WORKERS' ,:COMPENSA TION '.., , .J:' '" NO COVERAGE
7 . UMBRELLA ',' .. NO COVERAGE'! 11:;"
8 .'... OTHER - LINEBACKER . 780.00,C~).~,:
-.. '.:
. .
ill . ,],
.,. . ,,'
~ .. ..... .'l...~ ~ ~. /~
k ,f 1::1 ~', ._ ., ' .'.
I..., . :--. . ~,::\.r" ,.';
. ')..,. ,'~):"::~..
r"" -. .. r~
,".... '........ _ ' .1 '~,'.
. ~.. ...,
-----------------------------------------------------------------------
. ,.".;', ,c' ESTIMATED TOTAL POLICY PREMIUM .. $ 5,927.00 .
------------------------------------------------------------~-~I--[Qs+
FORMS APPLICABLE TO ALL SECTIONS EXCEPT: r ~ ydJ-r
1.. WORKERS' COMPENSATION
2.' , WHEN EXCLUDED ON SECTION DECLARATIONS
~ IL0017(11/85) IL7004(3/94)
.$"f:'
,'l;:THE" ADDRESS AND TELEPHONE NUMBER OF THE SERVICING COMPANY IS:
I#),j\:~ EMC ,:INSURANCE COMPANIES PHONE: (701) 223-8986
"," 897'
;~t:P.. o. BOX 1 _ ._ ' '" "A' "'. -.,
'i\r;\,BISM~RC"K)-:'ND~ ~~58502--1897 ''''J",','C ," :~(:as ',~r~' ' ,.:
:;~ . d'.' -' , 'r..
'-f -,/1.,. - -,; ,-
,.~;PLA,C~ fiOF',~SSUE~,,' BISMARCK-, NO.. .} :~".:'!;O:: ':""
:~iDAT "'OF ISSUE: '10/01/97 COUNTERSIGNED BY: ',ti"
:!)~:fOR..:::IL7.000A';(ED. u09-96) ,,-10/01/97 ,',~' , SL 1X37939
,;" ,," ...~, '~'1f,~; ".,I~>>j/ '" '~. . ' _ ,t. , ~~\ . _
-..-..
... "p
* 1 D 3 - 7 9 - 3 9---98 *
I *-----------------~------*
i N A fit E 0 I NS U RED: P R 00 U C E R:
- - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - -
SOURDOUGH RURAL fIRE DISTRICT WESTERN STATES INS. AGENCY, INC
140 EAST MAIN ST AGENT coPY
4541 S 3RD STREET PO BOX 430
BOZEMAN, "T.
BOZEMAN, MT. 597710430
59715 AGENT NO: AP-7350-4
AGENCY BILL
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ~
INSURED IS: FIRE DIST BUSINESS DESC: FIRE DIST
- - - - - - -, - - - - - - - - - _. - - - - -, - - - - - - - - - - - _. - - - - -
L~HITS OF INSURANCE
GENERAL AGGREGATE LIMIT (OTHER THAN PRODUCTS / COMPL OPS) S 2,000,000
PRODUCTS/COMPLETED OPERATIONS AGGREGATE LIMIT j $ 2,000,000
, PERSONAL AND/OR ADVERTISING INJURY LIMIT $ 1,000,000
EACH OCCURRENCE LIMIT $ 1,000,000
FIRE DAMAGE LIMIT (ANY ONE FIRE) $ 100,000
MEDICAL EXPENSE LIMIT (ANY ONE PERSON) S 5,000
,'.-"
~---------------------------------------------------------------------------
-
C 0 V ERA G E S PRO V I, D ED PRE M I U M
---------------------------------- -------------
OTHER THAN PRODUCTS/COMPLETED OPERATIONS $ 415.00
--------------------------------------------------
TOTAL ESTIMATED POLICY PREMIUM $ 415.00
---------------------------------------------'----
---------,------,- --,-------------,---------------------....----------
SEE ATTACHED SCHEDULE FOR LOCATION
OF ALL PREMISES OWNED, RENTED OR OCCUPIED.
------------------------------------------------------------------------------
FORMS APPLICABLE:
CG7001A(01-86) CG7003(03-96) CGOO01(01-96)
CG2147 (10-9.3) C62150(09-89) CG2256(01-96}
CG2021 (01-96) CG7128(OB-88) CG7129(08-88)
IL0021 (11-94) IL0243 (06-89) IL7039(11-93}
IL0167 (07-92) CG7110(01-86) CG0054 (03-97)
<:G0055 (03-97)
""DATE OF ISSUE: 10/01/97 BPP /
FORM CG7000A ED.01-86 09/30/97 002 SL 1037939 9801
. .-
(~POLICY PERIOD: FROM 11/01/97 TO 11/01/98 POLICY N~ER
~ * 1 K 3 - 7 9 - 3 9---98 *
*------------------------*
N A " E DIN SUR E D PRO 0 U C E R
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
SOURDOUGH RURAL FIRE DISTRICT WESTERN STATES INS. AGENCY, INC
140 EAST MAIN ST
4541 S 3RD STREET PO BOX 430 ... C,...rN
BOZEMAN, MT GENl' \jnr I
BOZEMAN, MT 597710430 Il(
59715 AGENT NO: A~50-4
AGENCY BILL
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
INSURED IS: FIRE DIST
- - - - - - - - - - - - - - - - - - _. - - - - - - - - - - - - - - - - - - - -
*****************************************************************
* T HIS I SAC L A I M SMA D E POL ICY *
* P LEA S ERE A DCA REF U L L Y *
*****************************************************************
L I M ITS 0 F L I A B I LIT Y
S 1,000,000 EACH LOSS
.It $ 1,000,000 AGGREGATE FOR EACH POLICY TERM
$ 2,000 INSURED'S DEDUCTIBLE PER LOSS
...... -.....,-------------------------....--....------------------------------------------
RETItOACTIVE DATE .. EXCESS EXTENDED REPOItTDIIi PERIOD:
THIS INSURANCE DOES NOT APPLY TO ..0N6fUl. ACTS "'ICN OCCUR
BEfORE THE RETROACTIVE DATE SHOWN8ELOW.
RETROACTIVE DATE: 11/01/96
AVAILABLE EXTENDED REPORTEM& PERIOD: ( 5 YEARS )
- ---------------------------------------,--------------------------------.....--
-------------------------------------
TOTAL ADVANCE PREMIUM $ 780.00
-------- ----------------.--------- ---
COVERAGE IS PROVIDED FOR BOARD AND ALL EMPLOYEES - WITH PERSONAL INJURY
(THE ADVANCE PREMIUM IS A MINIMUM PREMIUM FOR THE POLICY TERM)
A $ 100 MINIMUM POLICY PREMIUM APPLIES
IF POLICY IS CANCELLED AFTER THE EFFECTIVE DATE
-----------------------------------------------------------------------------
FORMS APPLICABLE:
I CL7001(01/91),CL7110(10/89),CL8117(01/91)
IL7036(OS/92),IL7062(07/92),CL7111(01/91)
-----------------------------------------------------------------------------
,DATE OF ISSUE: 10/01/97 BPP ~
FORM CL7000A (06-88) 09/30/97 002 SL 1K37939 9801
~,.,'- '-- . _.,- --- -.-'-. _.__.~~-- ,,------_.
iii ~ I' . """" .-.,...
. .... .. .... . . ." ~.- .. ... . "", ,. .. ." ... ... .
.: ',~;", "',/ ,:~. '.,' . -~ , ." ., . -,~, .. - '\'-",',.
i I . C lnsprance companIes
/ }-, \ / '. . BUS I N f.. \ \ ,,';,: I'"~ ,.1.,) ".p, L. 'c y SC:ctiD-J.. "
)/ c . r I _ _' _ 11 j S
, ':pLICY PERIOD.~_ ., -, . ~",,-,.,~
/'ROM: SEE SECTION DEC~'ARATIONS ."~~d *-----:-----~~-~-----:-------*
II 12:01 A.M. STANDARD TIME * ..~~~~ER' *
/- AT YOUR MAILING ADDRESS SHOWN BELOW * '1',~~_~";":.;.~7&f:;:,~'3'~'~;"''':-98 r
(UNLESS CHANGED ON THE SECTION DECLARATIONS) *---------~~-------------*
N A M E DIN SUR ED: PRO D',,,.U C E R :
- - - - - - - - - - .- - - - - - - - - - - - - - - - - - - ~ - - - - - - -
~crtiR'DOljGH-RURAti;:F'IRETiiOISTRICTJo WESTERN STATES INS. AGENCY, INC
4541 5 3RD STREET' "",~,,- -' 140 EAST MAIN ST--::
BOZEMAN, MT 59715 PO BOX 430 ~
BOZEMAN, MT 5977j-04~<:)1r '
, .-~N1
AGENT ~~50
AGENT'~HONE: 5~06)586-3351
.J', " _
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - ,~- - - - - - - -
INSURED IS: FIRE DIST BUSINESS DESC: FIRE DIST '"'t
- - - - - - - - - - - - - - - - - - - - - - .... - - - - - ~;:;~ - - .... - - - -
,-
I
IN RETURN FOR THE PAYMENT OF THE PREMIUM, ANDcSUBJECT TO ALL THE TERMS OF .
THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS '
POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE P~RTS FOR WHICH A ~2
PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJ~TMENT.- THE,i--
COMPANY AFFORDING COVERAGE IS DESIGNATED BY THE NAME IN n:tE DECLARATIONS'''<m~
OR INFORMATION PAGE~:FOR EACH SECTION OF, THE POLICY.
- - - - - ':'..,_ ,_ - - ;" _:_ __ - - ,- - -_.-~;~~~, - -E.-O-_ - _-~ - - -:: - - - - - - -
S E C T 10 N . ~'c;" C OV E R A.GE --" \. -:,!ns.P:RE,M I U-M,>F~-
.il.>,'. ; ------------- . -l.,.ri'~,. --------------------- .a, III -------------
If'' I" "I', I ,. "~'fdrt. ' .
" ',; 1 . ,,<. PROPERTY , " ~, ,'. ",' :$ ,J).... ,:352.00',' ai!,
,2 . LIABILITY'. 'j 415.00 I':
3 . ,:1> CRIME ' .'. " . -:'lyef~NO "COVERAGE :-F~j- '...
. 4 .. . , INLAND MARINE . 947.00
;, 5" . AUTOMOBILE C -~ . ';lOV ;0:" 3 433.0Q....,ES
6 . "lL WORKERS · COMPENSATION ..." . ':UC NO COVERAGE
7 "- ." UMBRELLA . :hJtl'- NO COVERAGE-'....';!
8 .:~', OTHER - LINEBACKER .~~l~ "-'.,780. OO:;;~~~
till -"'. . ; "'St...:'
v'
.. . ~ r
_. c . ellr '~ 'Or '.
~~. . ", .,";;;~ - ":;:':
. .. a: .,\ ,.~,-~
_ i",;: .:.. ,I -. . I';'"'
I '-
...- ~, . . .. _~ . "._~;F .. .
------~~--------~~-----------------~------------------~~~--------------
. -;" ' ESTIMATED TOTAL POLICY PREMIUM . $ 5,927.00 .
- --- - -- - ------ - ------- ---- - --------- ------------- ----------- 0-61 r- -[OSt-
FORMS APPLICABLE TO ALL SECTIONS EXCEPT: r . 'f~r
1.. WORKERS' COMPENSATION::
2. WHEN EXCLUDED ON SECTION DECLARATIONS
· IL0017(11/85) IL7004(3/94)
, ~Il" :~~':.f/" . ~f~' 1!;
\~'~THE ADDRESS AND TELEPHONE NUMBER OF THE 'SERVICING COMPANY' IS: ,-"
:A~:;'EMCINSURANCE CO~PANIES PHONE: (701) 223-89,86 ,"\ . ,,\\
j~.~+:i"=IS~~R~'~~ '~~~~ 58502:'1897 " ?'~ ~ S~r'.ICfJS :: 1'3 'lS' ~ -,\C-' \. ~\\/ " c:
~""iJ'" ' . ~ . .& ( I'U ,
,t',:,,,~,,,, , '" .." . ,;.,.,1.,," \(;'~" \:)
(~ . . ' .' ". ',u, I
". ';,i\:it:-. ." . -, . ,(",";:jr".g'~.:" . .' Y ('" '-'
,~E;;r'LACE,;.oF'ISSUE:, BISf'lARCK-" NO >~~-i;~~~;i~;:>,,~," "~~ -," ..,. ."f
f'JijbA~if>F'tSSUE.:10/(f1/97 COUNTERSIGNED BY: 'I" ,',f
~b~g~ ,~~:~L.J9~OOA-(ED.'~~:-96) ,1?I01{~7;'!:~\ 5L.,. 1X37939
N A M E D I NS U RED: PROD U C E R:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
SOURDOUGH RURAL FIRE DISTRICT WESTERN STATES INS. AGENCY, INC
140 EAST MAIN ST AGENT coPY
4541 S 3RD STREET PO BOX 430
BOZEMAN, MT.
BOZEMAN, MT.. 597710430
59715 AGENT NO: AP-7350-4
AGENCY BILL
- - - - - - - - - - - - - - -. - - - - - - - - - - - - - - - - - - - - - - - ~
INSUREn IS: FIRE 0151 BUSINESS DESC: FIRE DIST
- - - - - - _. - - - - - - - - - -, - - - - - - - -, - - - - - - - - - - - - - -
LIMITS Of INSURANCE
GENERAL AGGREGATE LIMIT (OTHER THAN PRODUCTS / COMPL OPS) S 2,000,,000
PRODUCTS/COMPLETED OPERATIONS AGGREGATE LIMIT j S 2,000,000
PERSONAL AND/OR ADVERTISING INJURY LIMIT S 1,000,000
EACH OCCURRENCE LIMIT S 1,000,000
FIRE DAMAGE LIMIT (ANY ONE FIRE) S 100,000
MEDICAL EXPENSE LIMIT (ANYONE PERSON) S 5,000
,I' .",
~---------------------------------------------------------------------------
-
C 0 V ERA G E S PR 0 V I. D E D PREMIUM
---------------------------------- -------------
OTHER THAN PRODUCTS/COMPLETED OPERATIONS S 415..00
-------------------------------'-------------- ---
TOTAL ESTIP1ATED POLICY PREMIUM $ 415..00
-----------------------------------------------'----
--------.--------------.--------------....------------------------------
SEE ATTACHED SCHEDULE FOR LOCATION
Of ALL PREMISES OWNED, RENTED OR OCCUPIED_
------------------------------....-----------------------------------------------
FORMS APPLICABLE:
CG7001A{01-86) CG7003(03-96) CGOO01(01-96)
~ C62147 (10-93) (G2150(09-89) CG2256(01-96)
CG2021 (01-96) CG7128(08-88) CG7129(08-88)
IL0021 (11-94) IL0243 (06-89) IL7039(11-93)
IL0167 (07-92) CG7110(01-86) CG0054(03-97)
CG0055 (03-97)
"DATE OF ISSUE: 10101/97 BPP /
FORM CG7000A ED.01-86 09/30/97 002 SL 1037939 9801
. -- ............,.. ~ '- - ~ . ~ ~..__._~_.~- .. ..w .......-- ~~. __......__,. ,~ _~. __ --- _._~",.. ---- - __~ ___ _._ __~__ __._ _.n'___~ _~ ~._~_r~,.'~.'____-....~
!iJ,*, - - .." - .
()POLICY PERIOD: FROM 11/01/97 TO 11/01/98 POLICY NUJ'IBER
1 K 3 - 7 9 - 3 9---98 *
*------------------------*
N A " E 0 INS U RED PRO D U C E R
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
SOURDOUGH RURAL FIRE DISTRICT WESTERN STATES INS. AGENCY, INC
140 EAST MAIN ST
4541 S 3RD STREET PO BOX 430 coP"'t
BOZE~AN. ~T~C;~~1r
BOZEMAN~ MT
597710430
59715 AGENT NO: A - 50-4
AGENCY BILL
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
INSURED IS: FIRE DIST
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -. - - - - - - - -
*****************************************************************
* T HIS I S A C L A I M S MAD E POL ICY *
* P LEA S E READ CAR E F U L L Y *
*****************************************************************
L I M I T S 0 F L I A B I L I T Y
$ 1~000,OOO EACH LOSS
e $ 1,000,000 AGGREGATE FOR EACH POLICY TER"
$ 2,000 INSURED'S DEDUCTIBLE PER LOSS
----------------------------------------------------------------------------
RETROACTIVE DATE AND EXCESS EXTENDED REPORTEN6 PERIOD:
THIS DlSURANCE DOES NOT APPLY TO IMOMiFUL ACTS _ICN OCCUR
BEFORE THE RETROACTIVE DATE SHOWNBELOU.
RETROACTIVE DATE: 11/01/96
AVArLABLE EXTENDED REPORTING PERIOD: ( 5 YEARS )
----------------------------------------------------------------------------
-------------------------------------
TOTAL ADVANCE PREMIUM $ 780.00
------------------------------------
COVERAGE IS PROVIDED FOR BOARD AND ALL EMPLOYEES - WITH PERSONAL INJURY
(THE ADVANCE PREMIUM IS A MINIMUM PREMIUM FOR THE POLICY TER~)
A $ 100 MINIMUM POLICY PREMIUM APPLIES
IF POLICY IS CANCELLED AFTER THE EFFECTIVE DATE
------,-----------------------------------------------------------------------
FORMS APPLICABLE:
, CL7001(01/91),CL7110(10/89),CLB117(01/91)
IL7036(OS/92),IL7062(07/92),CL7111(01/91)
------------'------------------------------------------------------------- ---
,DATE OF ISSUE: 10101/97 SP? /
FORM CL7000A (06-88) 09/30/97 002 SL 1K37939 9801
--~ .- .. .~.. -., .... -~ -- ~~-,.. ~ .-.....-...... ..'
":'~~~r" t _~~~." ." 11 ~ . '
~ .
.
SIGNATORY PAGE
GALLATIN COUNTY
FIRE PROTECTION MUTUAL AID AGREEMENT - 1997
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CENTRAL INSURANCE AGENCY CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
161 WEST HADISON POLICIES BELOW.
PO BOX 1170 COMPANIES AFFORDING COVERAGE
BELGRADE, lIlT 59714-1170 -- ,.'.~'-"..,",.'-
COMPANY A EMPLOYERS MUTUAL INS CO
LETTER
- ~~.."~ .~--"-
.__.,~-,.,-""-- ~.~. COMPANY B EMPLOYERS MUTUAL INS CO
INSURED LElTER
---~'"
BELGRADE RURAL FIRE DIST. COMPANY C EMPLOYERS MUTUAL INS CO
205 E. MAIN LETTER
._~, _~,~~~~"~~~_~~_~_'~~~'_,~M'~'~~~_
BELGRADE, lIlT 59714 COMPANY D
LETTER
--- --.-
COMPANY E
LETTER
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOlWlTHSTANDING 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_~ONDITIONS OF SUCH POLlCI~~~ LIMITS SHOWN MAY !'lAVE BEEN REDUCED BY PAID CLAIMS
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
I.TR DATE (MM/DDIYY) DATE (MM/DDIYY)
-
A GENERAL LIABILITY GENERAL AGGREGATE $ 1.000.000
X 1 CO""'OC'& "eN"" ",",,,n 101-35-55-97 7/1/97 7/1/98 PRODUCTS.COMP/OP AGG. $ 1.000.000
-=~J CLAIMS MADE l.iJ OCCUR. PERSONAL & ADV. INJURY $ 5 0 Q~2 Q
OWNER'S & CONTRACTOR'S PROT, EACH OCCURRENCE $ 500,000
...
FIRE DAMAGE (Any one,!i,~e) $ 50,000
_.~~,~, -~--~-
MED,EXPENSE(Anyoneperson $ 5,000
B AUTOMOBIl.E LIABILITY COMBINED SINGLE
LIMIT $ 500,000
ANY AUTO 1El-35-55-97 7/1/97 7/1/98
~~___~r
ALL OWNED AUTOS BODILY INJURY
(Per person) $
SCIIEOULED AUTOS
HIRED AUTOS BODILY INJURY
(Per accident) $
NON.OWNED AUTOS
. ."~ n..".._~..~'."' '~",'" .-----
GARAGE UABILlTY
PROPERTY DAMAGE $
C EXCESS LIABILITY EACH OCCURRENCE _. ~_..__m.1:!qQQ.!.. 0 OQ.
X UMBRELLA FORM 1Jl-35-55-97 7/1/97 7/1 / 98 $ 1,000.000
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION
EACH ACCIDENT $
AND
DISEASE..POLlCY LIMIT $
EMPLOYERS' L1ABILllY . . '.~"~'-~.."'-"."~'~'-~-"'-- ~"_r___'__
DISEASE--EACH EMPLOYEE $
OTHER
OESCRlPTlON OF OpeRA TlONS/LOCA TIONSNEHICl::S/SPEC:AL m,MS
q~Rt!f@Atg..ft9@iijfflU~.<t>:'::'.'.............<':.<.::.r ..i......).U.......!;:ANQg~tlQijU........))......}}i.............
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
GALLATIN COUNTY MAIL ~ DAYS WRIDEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
311 WEST MAIN STREET LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
ROOM jl0", LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES
BOZEMAN I MT 5 9715) AUTHoR,gr;p.,R,"PR.E:;~N.!~~E_---.._::;
........ 1~"
i ~- -7"
< .... "oi1tJ.,:;1 ?/..-.-.--.-~
AdQijti~S.S#Amj.):u..}:..4<(tf;/Gt:(,<3c.<:.,.,::;;".:~AciQflQqbRPQR*..nON1~'
- -
:
SIGNATORY PAGE
GALLATIN COUNTY
FIRE PROTECTION MUTUAL AID AGREEMENT - 1997
'~ECZe- Qee~ L}6(. r: /).
N~E OF ORGANIZATION
C;m~ C0J~ (?rli<=r
A HORIZED SIGNATURE
7- I - q+--
DATE SIGNED
J . bMC insurance ~om.panies
F '"
f.l' ,~S MUTUAL CASUALTY cru'")ANY PRr'~ POLICY: OD7-30-85
t
f G ENE R A L L I A B, I LIT Y D E C L A RAT ION S
, *------------------------*
;>ERIOD: FROM 12/21/97 TO 12/21/98 * POLICY NUMBER *
* 0 D 7 - 3 0 - 8 5---98 *
*------------------------*
NAMED INS U RED: PRO D U C E R:
- - - - - - - - - - - - - - - - - - - - - - - - - ~ - - - - - - - .- -
.i CREEK VOLUNTEER WESTERN STATES INS. AGENCY, INC
'. SERVICE AREA
i 400 MISSOURI AVE
,0 GEE-NORMAN ROAD
DEER LODGE, MT.
.ld' .~ADE, MT. 597221079
l' .. AGENT NO: AP-7427-2
't, .1RECT BILL
:i; - ~ - - - - - - - - - - - - - - - - - - ~ ~ ~ - ~ - - - - ~ - - - - -
~' IS: FIRE DEPARTMENT BUSINESS DESC: FIRE DEPARTMENT
~,: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -. -
~ OF INSURANC E
.~AL AGGREGATE LIMIT (OTHER THAN PRODUCTS I COMPL OPS) $ 1,000,000
:1". ,JeTS/COMPLETED OPERATIONS AGGREGATE LIMIT $ 1,000,000
,)NAL ANDIOR ADVERTISING INJURY LIMIT $ 500,000
'. OCCURRENCE LIMIT $ 500,000
DAMAGE LIMIT (ANY ONE FIRE) $ 100,000
~ ;CAL EXPENSE LIMIT (ANY ONE PERSON) $ 5,000
4 ._----------------------~-~----------------------~-~~~~~~------~----~-----
.OVERAGES PRO V IDE D PRE M I U M
._---~-----------~----~~-----~---- .........-~-~-~--~---
JTHER THAN PRODUCTS/COMPLETED OPERATIONS $ 185.00
-----~------~~~-----------------------~~--~~--~.._--
TOTAL ESTIMATED POLICY PREMIUM $ 185.00
---------------~--------------~~-~-----~~-~~~~~--~-
-~--------------------~-------------------------------~~~-------~------
SEE ATTACHED SCHEDULE FOR LOCATION
OF ALL PREMISES OWNED, RENTED OR OC~UPIED.
~--~-~--------~------~---------------------~-~---~-~~-------~-~~~~-~~~--
~... .PPL I C ABL E :
CG7001A(1-86) CG7003(3-96) CGOO01(1-96)
CG2147(10-93) CG2150(9-89) CG2256(1-96)
CG2021(1-96) CG712B(8-88) CG7129(8-88)
IL0021(11-94) IL0243(6-89) IL7039(11-93)
, IL0167(7-92) CGOO54(3-97) CG0055(3-97)
j . ISSUE: 11/21/97 BPP /
.7000A ED.01-86 BPP 11/19/97 002 DK 0073085 9801
, .
,
FROM : CHURCHILL EQUIP CO. PHONE NO. : 406 282 73;:' P01
. EMe Insurance Companies
I.MPLOYERS MUTUAL CASUALTY COMPANY -"-,_.,,.. -. "-
PRIOR POLICY: 006-60-38
~ G EI N E
R A L L I A 8 I L I T Y 0 E C L A R A T ION S
"'ICY PERI *----- .----------------*
0: FROM 07/01/97 TO 07/01/98 '" POLICY NUMBER *
* 0 D 6 - 6 0 - 3 g---98 *
*------------ .,,----------*
N A E 0 INS U R E D: PRO 0 U C E R:
-- - - - - - - - - - - - - - - ~ ~ -- _. .~ '- - - - ~ - - - - - - ~ - - - -
AI"ISTERDA RURAL FIRE "'ESTERN STATES INS. AGENCY, INC
DISTRICT
" DENNIS TREASURER 2925 PALMER STREET SUITE: B
6075 MON PO sox 4386
MISSOULA, MT.
MANHATTA 598064386
59741 AGENT NO: AP-7430-4
AGENC BILL
----- - - - - - - - - - - - ~ ~ - ~ ~ ~ ~ - ,- - - ----- -----~
';NSURED IS: IFIRE DISTRICT BUSINESS DESc: FIRE DISTRICT
- - - - - 1- - - - - - - - - - - - - - - - - - - - - ~. - - - - - - - - .... - -
nUTS OF INSURANCE
GENERAL AGGREGATE LIMIT (OTHER THAN PRODUCTS / COMPL OP$) $ 1,000,000
PROOUCTS~COMPLETEO OPERATIONS AGGREGATC LIMIT S 1..000,000
PERSONAL AND/OR ADVERTISING INJURY LIMIT $ 500..000
EACH OCC RRENCE LIMIT $ 500,000
FIRE DAM GE LXMZT (ANY ONE FIRF) S 100,000
MEDICAL eXPENSE LIMIT (ANY ONE PERSON) S 5..000
I
I
.--------i---------'-------~-'--'-----'--'- -- - - - - ----- - '., -.--.-----.-----.----------
C 0 V .ERAGE 5 PRO V IDE 0 PRE fill I U '"
-----1---------------------------- --.- --,----~~~--
OTHER THAN PRODUCTS/COMPLETED OPERATIONS $ 536.00
-- ----~~-~~~ - ... - -.-,-.- ~ - ~ ~ ,_. ,.. - - ~. ,- - -- ~ - ,. ,- ~ - ,- - - - - -- - - - - -
ToTAL ESTIMATED POLlCY PRE""IUM $ 536_00
---------'---------- -~-------,-,_._---------~--------
!
i
I
----------t--------------------------------------- ------- ------------------
SEE ATTACHED SCHEDULE FOR LOCATTON
OF ALL PREMISES OWNED.. RENTED OR OCCUPIED.
._----_._-~~-~---------~---_._-_._._-'-'-_._._.,_._~-'--_._--'--~-- .-:'-'--'-,. ._-,--------------
aRMS APPLIIABLE:
G7001A (01-86) CG7003(Q3-Q6) CGOOO1(Q1-Q6)
GZ147(10-Q3) CG21S0<09-89) CG2256<01-Q6)
GZ021(01-96) CG7128<08-88) CG7129<OB-88)
67127(03-96) IL0021<11-94) IL0243(06-8Q)
~L7039<11-93) IL0167(07-Q2) CG8057(Q1-96)
.. (GOO54<03-97) CGOO5S<Q3-97)
ATE: OF BPP /
!'TI:1M . U~I 'IV/9 { 002 .....--.. "".'"""LR OD66U5R 'oI~u1
-
:
GALLATIN COUNTY FIRE PROTECTION MUTUAL AID AGREEMENT
SIGNATURE PAGE
)YY)l1.^L-JI hv-t
Organization
/ I.
f/ "7 f /
- ,---:- //'J / -- . y~L I t/z~'/HJJ / ;/~~(/f 5
;J '7c, ; f- .I;!/ ( C!1 / t /VI/- '/1t L-
Title / S~gnature ------ ,Date
,/
'/ vi
Organization
Title signature Date
Organization
Title Signature Date
organization
Title Signature Date
Organization
Title Signature Date
RC\ B~':Kil1k,,',,; J : :)- :l-:JH ;1I::WI'\1 : ,\.Ill; GIl7 1.:lHlj- k.1\KO'$ B()ZE~I.'\\ \1'1':1,.)
J__.'::::::-'::'~::~-~-:.':""~.=:":::.~' -''-1'-1 -'_I .......--.. __""____ . ",,'......,."-/ I I I.................' __-
9QIoI01530 ~(C~;'7 ...
~ INSUrlED ...",FiJrmBure&l
Family of Insurtlnce Services
\ MOUNTAIN wEST FARM BuREAU ~UTUAL INSURANCE COMPANY
P.O. BOX 1348 LARAMIE. WYOMING 82070-1348
BUSINESS SqUIRE CON~N POLICY DECLARATION
6/08/97 WS150
,1.1.1,1111...11111111. .1
SPRINGHILL RURAL POLICY NUMBER 90~01530
FIRE OEPT COUNTY 45 AGENi 914
9&00 WALKER RO TERM 1 YR THOMAS TUCK
BELGRADE MT 59714
BUSINESS DESCRIPiION: RURAL FIRE DEPT
INSURED IS NON-PROFIT.
POLICY PERIOO FROM 6/11/97 TO 6/11/98 AT 12.01 A.M. STANDARD
TIME AT YOUR MAILING ADDRESS SHOWN ABOVE.
This pol icy consists of the following coverage parts for which a
premi~m is indieated. This premium may be $ubject to adjustment.
COMr\ERC I Al PROPERTY COVERAGE PART. ..... 150.00
COM~ERCIAL CRIME COVERAGE PART. . .. ... .. .. .00
COMKERCIAL GENERAL LIABILITY COVERAGE PART. . . . . .. . . 353.00
COMI'\ERC I AL AUTO COVERAGE PART . . . . . .. 460.00
COMERC I AL GARAGE COVERAGE PART . . . . , .. .. . . . ,DO
COMI'\ERCIAl INLAND MARINE COVERAGE PART. . . . .. , .".. .00
COM~ERCIAL UMBRELLA COVERAGE PART . ..... ,..... .00
---~~-~......_-...
TOTAL ANNUAL PREMIUM 963.00
The premium shown in the declarations was computed based on rates in
effect at the time the ~olicy was issued. On each renewal t continuation,
or anniversary of the effectIve date of this policy. loIe will compute
the premium in accordance with our rates anQ rules then in effect.
Coverage rORMS and ENDORSE~ENTS made part of this pol icy at time of issue -
fO-10.l1l(Olt/6Sl FO-l0.115(O.LtL88) 'FO-l0,lZ,I(Q4/S8)
FO-10.116(041B8 IL 00 OlC06/8f) IL 00 17(11~8r)
I L 00 21111/85] I L 01 b7 07/~2 I L 02 43 l'Ob/ 9 10.100 (04/96)
IL 01 80 12/!~ CP 00 10 10/ 1 CP 00 90 07/ 8 CP 10 lO~10/i1~
CG 00 01 10/ 3 CG 2104 11/ ~ CG 21 4! 10/93 CG 214 10/ 3
CG 214 10! 3 CG 2 44 10/9 CG 22 5 11/85 CG 24 0 10/ 3
20.003(64/96 20.20t(0416) 0.212(041) CA 00 01 (12/ )
CA 00 29 (J 21 8) CA 9~ 0 3 ~ 12/93) CA 0 2 ~o (05/94) CA 20 ~L 12193)
CA 20 30 (12/93) CA 2 I 0] ~12/93) CA 21 52 (09/94) 30.102 (04/96)
10.005-(Olt/96J
MORTGAGE CLAUSE- If a MORTGAGE and/or LOSS PAYABLE Glause(s) shall
be .pplieable.
This declaration replaces at 1 declarations previously issued to you
for this policy.
T"i~ i.~ot effect'~e unt" "gne. by ou, .utho"..d '.p,.sent.tiv..
---------------~---~~---
COUNTERSIGNATURE
FO-10.ll1 (04/88)
IK~_}3~~,K ~ ~l~'~' 'I S_~. _-! : :1 1. ~ JH ; I I :;~ II '\1 ; __." .._ ,~;\,~t.>_,:::-~17 I ;~ll(j-. K I "'KO 'S LjOZE\IA', \IT; /I ""-
t...... '-I ......__ I .... ........... ~ ' , r .\_J....... ...... 1
sOlie 1 SJO 5,1 DB/ g 1 . .. Fann BUreau
INSul'l~D
F.m,1y of Insurance Services
BUSINESS SQUIRE ADDITIONAL POLICY DECLARATION WS1532
CO~MERCIAL GENERAL LIABILITY ~OVERAGE PART
EFFECTIVE 6/11/5~
POLICY NO. 90MOl 0 NAME SPRINGHILL RURAL 6/08/97
LIMITS OF INSURANCE
GENERAL AGGREGATE LIMIT ~OTHER THAN PRODUCTS/CO~PlETEO OPERATIONS) 1,000.000
PRODUCTS/COMPLETED OPERA IONS AGGREGATE LIMIT NOT COVERED
~ERSONAL AND ADVERTISING INJURY LIMIT 1,000,000
EACH OCCURRENCE LIMIT 1,000.000
FIRE DAM~GE LIMIT to 000
ANY ON FIRE
MEDICAL EXPENSE LI~lT ~.OOO
ANY ONE ERSON
LIABILITY DEOUCTIBLES PER OCCURRENCE aOOILY INJURY *N ON E *
LIABILITY DEDUCTIBLES PER OCCURRENCE PROPERTY DAMAGE *NONE*
THE FOLLOWING DISCLOSES ALL INSURED OPERATIONS KNOWN TO EXIST AT THE
EFFECflVE 04TE OF THIS POLICY. ANY UNDECLARED OPERATIONS ARE NOT COVEREO.
LOC. BLO. TYPE DESCRIPTION
NO. NO. CODE
00 00 4 FIR; DEPART~ENT$ NOC
LaC. 9 00 WALKER RD-BELGRAOE MT
INClUOING PRODUCTS AND/OR COMPLETED OPERATIONS, SU8JECT TO
THE GENERAL AGGREGATE LIMIT
01 ENDORSEMtNT CG 22 ~4(10/~f)
EXCLUSION - HEALTH OR COSM Ie SERVICES
EMT
TOTAL PREMIUM 353.00
TYPE CODE
1-0~MERS/CO~TRACTORS PROTECTIVE 7-PROOUCTS/COMPLETED OPERATIONS
4-P~EMISES/OPERAiIONS
6-0ESlGNATEO CONTRACTS
. FO-\O.115 (4/88)
I
I
GALLATIN COUNTY FIRE PROTECTION MUTUAL AID AGREEMENT
SIGNATURE PAGE
Pet'" A..,.L~ 1.)/1 / J<-"1 h~J < . t2 - tE:~u-~ Lr:-;.....-I-
\~").b~J _-U-~'- . -- .f
organization .
1
Ci?,l-L/ ---~/~ ;zf: ----;J '7 ':;,:,.,""
_ . r . . -11 (~ " , /t.'~t.---- ..)-/--/d
Title I '~signature // Date
- ~~ .-
Organization
Title Signature Date
Organization
Title Signature Date
organization
Title Signature Date
organization
Title Signature Date
0 .
-. 0,
-
Montana Municipallnsu. ~_Ilce Authority
January 13, 1998
GALLA TIN COUNTY
RE: Certificate ofInsurance relating to the Town of West Yellowstone
To Whom It May Concern:
I am in receipt of a request from the Town of West Yellowstone to provide your organization
with a Certificate of Insurance relating to insurance coverage for that Town. You will find such a
document attached.
The Town of West Yellowstone is insured by the Montana Municipal Insurance Authority
(MMIA). The MMIA is a self-insurance organization that provides liability and/or workers'
compensation coverage exclusively to 113 incorporated Montana municipalities. The Certificate of
Insurance details the specifics of coverage as per your request.
If I can be of further assistance do not hesitate to contact me.
Sincerely,
~~.t -2f;A-a~7~ y
Bob Worthington
MMIA Programs Administrator
attachment:
cc: Alan Harper
Town of West Yellowstone
P. Q. Box 785, Helena, Montana, 59624 (406) 443-0907 In MT: 1-800-635-3089
.
.
A4~4.IU..
. ~ ' ,
PRODUCER THIS CEnnFICATE IS ISSUED AS A MA TTER OF INFORMA nON ONL Y AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICA TE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
MONT ANA MUNICIPAL INSURANCE AUTH.. POLICIES BELOW,
p, O. BOX 785 COMPANIES AFFORDING COVERAGE
HELENA, MT 59624 f~T~~~NY A
mana Municipal Insurance Au
COMPANY B
f~~'N OF WEST YELLOWSTONE LETTER
P.O. BOX 1570 ~~~~~NY C
400 YELLOWSTONE AVE. COMPANY 0
WEST YELLOWSTONE, 1'.1T 59758 LE nER
COMPANY E
I.E1TEI1
:CQVERAQ1:S~ ,.~t~: ~ '. :t~: ~t; ~;\ ,/oj "::ft" '{::;'.'/ s;.(;~.:;~';;"f:~$'{~~~f~~~>11~1 r~I~1~il :~~~ ~j ;,;~; ~ ~~::~~"':~~~I~~,~ t:t"'~,'~':' :^ 4.:,~~\~~\l~\~~~ :~i1%~l~?t:~, r,,~~f,1~';1.:I. ."' ~~' , .....",.'-.. "."-i,...~:
THIS IS TO CERTIFY THA r THE POLICIES OF INSURANCE LISTED 8ELOW HAVE Bl'OF.N ISSUED TO THE INSlHlED NAMED ,\GOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REOUIHEMENT, TEflM OR CONDITION OF ANY CONTRACT OR OTHEf1 DOCUMEnT WITH RESPECT ro WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRI8ED HEflEIN IS ~3lJI3JECT TO ALL rHF. n,RMS,
E:<CLUSIONS AND CONDITIONS OF SUCH POLICIES
. - ~,~-,~.. _.~~,
CO TYPE OF INSURANCE POLICY NUMBER POLICY ~FFECTIVE POLICY EXPIRATION LIMITS See Below
UR DATE (MMIOD/YY) DATE (MMIDDIYY)
GENERAL LIABILITY [JODII.Y IN.!UI1Y OCC. ~ ;,;~
... -.. --
COMPREHENSIVE FOIIM BODilY INJURY AGG, ~ "
-
PREMISES/OPERA TIONS PROPEIHY OAMAGF occ. $ "
UNDERGROUND .~-~ -
EXPLOSION & eOU.APSE HAZARU PROPERTY [lAMA(;r: AGO. $
~~-~,
PRODUCTS/COMPLETED OPER 131 p, PIl COMBINED oee. ~
..- .-
CONTnACTUAL BI ~ PO COMBINED AGG $
~. ~.~~ . "
INDEPENDENT CON r I1ACTORS PERSONAL INJUI1Y AGG. $
BROAD FORM PROPERTY DAMAGE .....
[lOIlIL Y ItlJURY $ 750,000
(P,.~r' per~onl
-,-~-,.~'..,"~- ~_._-
ALL OWNED !\lHOS ( P,;". Po",. I I)OI)II.Y INJIJIW
ALL OWNED AUTOS ( ~:!:"'p:~~n ) (Pl'r ,Ic\'id~~tll) "
-.. r;S1JO,OOO ~.,..
HIRED AUTOS
NON-OWNED AUrOS f'ROPEr\ IY ON~A~ t .
___._~CLe_ XI~nC;U,-,x~e.s
GARAGE UAIJILlTY IJODII_Y~V.~A' , d d 'bl '
PROPEl I . ~urre ~e e uetl e 01
COMIJINIOU
EXCESS LIABILITY !OACH OCCllHHEtKE
-~~, -,..~,-- _._,-~,,,_..,--_._-'
UMBRELLA FORM /\GGr~EGA r r~
~-
o rHER THAN UMBRELLA FORM
WORKER'S COMP!;'NSA TION .-- ST~"I:UTORY L'::..N-X- XXXX_..__
reACH ACCIOE:Nf $
A AND n. ." ._---~~
N/A Jul1,97 J 11,98 DISEASE -POLICY L1MI r $
EMPLOYERS' LIABILITY -~.~--~....- __ _r ..-
DISEAS~-. EACH eMPLOYEE :,
I)THFR
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICL!;'S/SPECIAL ITEMS
- . . -
SHOULD ANY OF THE ABOVE DESCRIBF.D POLlr;IES BE C^NCF.LLED I3EFORE THE
"ALLATIN COUNTY EXPIRA nON DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR ro
EST YELLOWSTONE, MT 59758 MAIL ~ DAYS WI~ITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAlblO1E TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLlGA nON OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES
Ol' . .. I- . . - . - I . ~ ~ I
: .
_~-:ontana Municipal Insul ce Authority
January 13, 1998
GALLA TIN COUNTY
RE: Certificate ofInsurance relating to the To\VIl of West Yellowstone
To Whom It May Concern:
I am in receipt of a request from the T 0\VIl of West Yellowstone to provide your organization
with a Certificate of Insurance relating to insurance coverage for that To\VIl. You will tInd such a
docurnentattached.
The To\VIl of West Yellowstone is insured by the Montana Municipal Insurance Authority
(MMIA). The MMIA is a self-insurance organization that provides liability and/or workers'
compensation coverage exclusively to 113 incorporated Montana mWlicipalities. The Certificate of
Insurance details the specifics of coverage as per your request.
If I can be of further assistance do not hesitate to contact me.
Sincerely,
~~;t 5t7~'-7~ r
Bob Worthington
M:MIA Programs Administrator
.
attachment:
cc: Alan Harper
To\VIl of West Yellowstone
P. O. Box 785, Helena, Montana, 59624 (406) 443-0907 In M T: 1.800-635.3089
.91~lt.
. ' - ,
etR THIS ceR flFICA Te IS ISSUED AS A MA neR OF INFORMA TION ONLY AND
CONFERS NO RIGHTS UPON THE CERTlFICA TE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR AL TEn THE COVERAGE AFFORDED BY THE
.vlONTANA MUNICIPAL INSURANCE AUTH.. POLICIES BELOW.
, p, 0, BOX 785 COMPANIES AFFORDING COVERAGE
HELENA, MT 59624 ~~T~~~NY A
f1SB:~EIte-r.
1{jWN OF WEST YELLOWSTONE ~~T~~~NY B
P,O, BOX 1570 ~~~~~NY C
400 YELLOWSTONE AVE. COMPANY 0
WEST YELLOWSTONE, MT 59758 LETTER
I ~~T~,~~NY E
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NM,lED 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.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRA lION LIMITS See Below
LTR OATE IMMIDDIYY) DATE (MMIDQIYY)
GENERAL LIABILITY 8001\. Y INJURY OCC. S "
COMPREHENSIVE FORM 130DIL Y INJURY AGG. S "
PREMISES/OPERA TIONS PROPERTY OAMAGE OCC. S "
UNDERGROUNO PROPERlY DAMAf;E AGG. s
EXPLOSION'" COLLAPSE HAZARD
PRODUCTS/COMPLETED OPEA. 131 !, PO COMI3INED OCC, $
CONTRACTUAL 131 ~ PO COMBINED AGO. S
INDEPENDENT CONTRACTORS PERSONAL INJURY AGO, $ "
BROAD FORM PROPERTY DAMAGE "
filubtitC'E'Flii'" Liabilitv
BOOll Y INJURY S 750,000
ANY AUTO (per perSC)J1)
-
ALL OWNED AUTOS ( P,;V, Po",. ) IJODIU INJURY $
ALL OWNED ,\Ures ( ~;::~'p:~:~) (PPf ::'ICC1dfln1)
1,500,000
I~IRED AUTOS rROPEIl TV DAMA~ $
NON-OWNED AUTOS er OC .rrenc~E~
GARAGE LIABILITY 130DII Yt:1}:~ Asic d d 'bl
pnOPE ,'urre 'Ie e uctJ e of
COMOlflELl
E~CESS LIABILITY EACH OCCUllRENCE
UMBRELLA FORM ,\GGREGA fE
OTHER THAN UMBRELLA FonM
WORKER'S COMPENSA TION I srAfUWf1Y L1~N::.X
EACH ACCIDF.NT
A ANO N/A Jul 1,97 J OISEASF __POLICY I.IMI T $
11,98
EMPLOYERS' LIABILITY Oj~E.^.Sf::-f:^CH EMPlOYEF $
\ 0 THER I
DESCRIPTION OF OPI:RAT10NSILOCATIONS/VEHICLI:S/SPECIAL ITEMS
::\- . . . .
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRA TION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
~ALLATIN COUNTY MAil _ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
EST YELLOWSTONE, MT 59758 LEFT. BUT FAIJ.~E TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY. ITS AGENTS on 1'lF.PRESENTATlves.
AUTHOf,j'ZED REPRESENT A TlVE
. ! = I
:.....':
.
GALLATIN COUNTY FIRE PROTECTION MUTUAL AID AGREEMENT
SIGNATURE PAGE
.J/7.n~;:,ti;P1.l VfJ.U/.:( r<U~t)L riaL f)15'J
Organization fdf44col
cI~ Q/ /'-7,)'
Title Signature /Date
Town of WhiT.p-hall Fire Dept.
Organization
1
Mi'lynr ~ ---'L~c~ 3/12/98
Title Sign?-~e Date
organization
Title Signature Date
organization
Title Signature Date
Organization
Title Signature Date
I
I
I
I TOWN OF WHITEHALL
I
I Box 539
I Whitehall. MT 59759
I (408) 287-3872
TO Brian Crandell DATE 5/6/98
P. O. Box 1103
Bozeman, MT 59771 SUBJECT: Proof of Ins. re
Mutual Aid Agreement
Whitehall Fire Dept.
Brian,
~,,--~"-
As per our telephone conversation, enclosed is proof of insurance
which covers our fire department.
Please call me if you have any questions.
SIGNE~
o Please reply o No reply necessary Sue-Ellen Downs, Clerk/Treas.
MLCC 300.2
f'RINTF.DIN U,5.A.
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MONTANA MUNICIPAL INSURANCE AUTHORITY
MEMORANDUM
OF
LIABILITY COVERAGE
MEMORANDUM #
L-0075-97
OeCLARA TIONS
"ENTITY COVERED: TOWN OF WHITEHALL MONTANA
ADDRESS: 2 N. WHITEHALL STREET
WHITEHALL, MT. 59759
COVERAGE PERIOD: FROM: JUL 1, 1997 TO: JUL L 1998 12:01 A.M.
DEPOSIT PREMIUM: $7,473.
DEDUCTIBLE $750. PER OCCURRENCE
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MAXIMUM POLICY LIMIT:
(a) $750,000 for an Occurrence which arises or derives from
inj ury to or death of a single person, or damage t.o
property of a single person, regardless of t.he number of
persons or entit.ies claiming damages thereby.
(b) $1,500,000 for each Occurrence which does not. fall under
(a) above.
Endorsements Attached:
By DATE JUL. L 1997
,
,t ZV:"~Il)j~;I2~aN~~\1ii\_' ,
A4~~tl~lt. I~~UE U^ I r. (Mt..1/l.JU/YY)
5-5-98
,t .. ,.
PROOUC~R THIS CER flFICATE IS ISSUED AS A MA TTER OF INFORM A nON ONL Y AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICA TE
Montana Municipal Insurance Auth. DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
P. O. Box 785 POLICIES BELOW.
Helena, MT 59624 COMPANIES AFFORDING COVERAGE
COMPANY At1
,-"TlEI1 on tana Municipal Insurance Authoritv
INSURED f~t:~~NY B
Town of Whitehall, Montana COMPANY C
IF.TTER
2 N. Whitehall Street
Whitehall, MT 59759 COMPANY 0
LE rtEI1
COMPANY E
LEnr:n
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THIS IS TO CERTIFY THAT THE POI.ICIES OF INSURANCE liSTED BE''-OW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE fOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OFl CONDITIQN OF ANY cmlTRACT Of4 OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUB.JECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SIJCH POUCIES.
.... -.--- ,-~,~, _.~'- . ~-'-.
CO TYPE OF INSURANCE POLICY NUMllI:R POLICY EFFECTIVE POLICY EXPlRA TION LIMITS
LTR DA fE IMMIIJD/YY) DATE IMM/DD/YY) See Below
GENERAL LIA61lJTY !JO\JII.Y IN,JUflY Oce. $See Below
COMPREli~NSIVE FOI1M ROIJllY INJURY AliG. $ 11
PREMISES/OPERA T IONS PROPFllfY OAMMlE OCC. $ II
UNDEmlnOlJND -. ---..
UPLOSlotl & COLLAPSE HAlARD pm1l'FIl ry DAMAnE AOG, $ "
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PIlODUCTS/COMPlE rED OPER, 131 1\ PO GOMBINELJ OCC. $ "
CONTRACTUAL III ,~ PO COMOINE!) AOG .~ 'I
-,~,..~
INDEPENDEN f CON TflACTOnS p[n~lON^L IN..Iuny N.3G. $ 'I
BI10AD FORM pnOPEflTY DAMAGE
A ubJl!-il!!lJLEln tit
AUTOMOBILE LIABILITY
A X IIrIY AUTO L-0075-97 $750,000
-~~-~~_."--~-
ALL OWNED AUTOS ( POv, Poes. I 1l0011.Y IN.Hlny
ALL OWNF.O AUTOS ( 011"" Thon I (p(!( (Icridpnl) $1,500,000
Prlv. Pass. - -p-er--o c nff-r e Excess
HIr1EO AUTOS ce.
NON,OWNeD All fOS Cl'V~2:JY ~'r"E 0 C c trence
,. IJOllll,Y 1~J.IUf1Y ti'a:eaU' fa5Te ot
GARAGE LIABILITY
['IlOPFRlY [)AMAl,E $750.00
COMIlINI'oLJ
EXCESS LIABILITY EM;'! oCCUlmENCE $
~_._~--,.----------~~~ ---,~~
UMBRELLA FORM ,i\(J{C;REn^TE $
o rHEn THAN UMlJl1fLLA EOllM
STATUTOf1Y (,IMIIS XXXXXXX
WORKER'S COMPENSATION -~~ -~~~---'-
A EACH ACCIDENf $
AND N/A ul 1, 97 Jul 1, 9 ~--~~--~~-
DI~;EASE-I'OUCY LlMI f $
EMPLOYERS' lIAElILITY _.,~~...----'.-......----------~
QISrASE-FACH EMPLOYEE $
OTHER
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DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/SPECIALlfEMS
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Gallatin County EXPIr:3'BON DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
ozeman, MT MAIL _ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
U::FT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPfiESENTATlVES.
t . . . , - ;H . ... - . . ... ~ . - , t . ~ .
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:lUSINESS o TRuex INSURANCE EXC' 'GE 0 MID-CENTURY INSURANCE COMPANY .~ FARMERS INSURANCE EXCHANGE
mTO
~LARATIONS 0
POLICY MEMBERS OF FARMERS INSURANCE GROUP OF COMPANIES
XJ CUVfRA6E PART HOME OFFICE: 4680 WILSHIRE BLVD., LOS ANGELES, CALIFORNIA 90010
TEM ONE
NAMED JEFFERSON VALLEY RURAL FIRE
INSURED DISTRICT Prematlc Ace't No. Prod, Count
MAILING BOX 616 7n-11-!;41 n6!;Rn-4n-~n
ADDRESS Agent Policy Number
WHITEHALL MT 59759
Type of
rhe named insured is an individual OCJnershiP ~rp. Business VOL FIRE DEPT
,"less otherwise stated: Joint Venture Organization (other than Partnership or joint venture)
'olley Period from 03/06/98 (not prior to time applied for) to 03/10/98 12:01 AM Standard Time
f this polley replaces other coverages that end at noon standard time on the same day this polley begin., this polley will not take effect until the othe
:overaqe ends. This polley will continue for successive pollC~ periods as follows: If we elect to continue this insurance. we will renew this policy if)'Qu pa
,he reqUIred renewal premium for each successive policy periOd su ject to our premiums. rules and fonns then in effect
ITEM TWO SCHEDULE OF COVERAGES AND COVERED AUTOS
'This PCJ:l Jlltlvides only those coverage:fwilerea cha~t:'-sf1own inUre premium"column below- Each of these coveragos..wllLal1Ply only to those 'autos' show
IS cove autos.... "Autos'" are shown as covered "'au os' for a particular coverage by the entry of one or more of the symbols from the cOVEi\ED AUTO Sectio
)f the Business Auto Coverage Fonn next to the name of the coverage,
.. COVERED AUTOS LIMIT
THE MOST WE WILL PAY FOR PREMIUM
COVERAGES ANY ONE ACCIDENT OR LOSS
(LIMITS SHOWN IN THOUSANDS)
LIABILITY 7 $ 1000 832.00
~ERSONAL INJURY PROTECTION SEP ARA TEL Y STATED IN EACH PIP ENDORSEMENT
[or equivalent No-Fault Coveraae)
~ODED PERSONAL INJURY PROTE~TION SEPARATELY STATED IN EACH ADDED PIP ENDORSEMENT
for equivalent added no-fault COY,
PROPERTY P~~FTlON INSURANCE SEP ARA TEL Y STATED IN THE P,P.I. ENDORSEMENT MINUS
'Michiaan onl $ DEDUCTIBLE fOR EACH ACCIDENT
Il.UTO MEDICAL PAYMENTS 7 $ SEE SCHEDULE 61.00
UNINSURED MOTORIST 7 $ 1000 55,00
UNINSURED MOTORIST $
PROPERTY DAMAGE
UNDERlNSURED MOTORlSTS~en not $
fncl. in Uninsured Motorists overaael
PHYSICAL DAMAGE Actual Cash Value or Cost of 'tEair. whichever is
COMPREHENSIVE COVERAGE 7 less minus $ SEE SCHEDU Oed, for Each Covered 228.00
Auto. But no Deductible A~PlIes to Loss Caused by Fire or
Ullhtnina, See Item Four or hired or borrowed ...autos....
PHYSICAL DAMAGE SPECIFIED Actual Cash Value or Cost of Repair. whichever Is
CAUSES OF LOSS COVERAGE 7 Less Minus $25 Oed. for Each Covered Auto for loss
Caused by Mischief or Vandalism. See Item Four for hired
or borrowed ..Autos....
PHYSICAL DAMAGE Actual Cash Value or Cost 01 Relair whichever Is
COLLISION COVERAGE 7 less minus $ SEE SCHEDUL Oed. for Each Covered 577.00
Auto. See item four for hired or bollOWed ..Autos....
PHYSICAL DAMAGE $
TOWING AND LABOR for each (disablement of a private passenger
"'auto,'" ACTUAL LIMIT)
I PREMIUM FOR ENDORSEMENTS
I ESTIMATED TOTAL PREMIUM 1 .753.00
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_'10 31\0 EDITION 12-11 e.g2 PAGE I OF ~
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06580-if6-36
POLICY NUMBER
BUSINESS AUTO DECLARATIONS (Continued)
ITEM THREE
SCHEDULE OF COVERED AUTOS yOU OWN
DESCRIPTION TERRITORY
PURCHASED
Year. Model. Trade Name, Bocfy 1'Ype Town & State where Covered
Serial Number (8) Vehicle Identillcatlon Number Original Actual Cost & Auto wUl be principally garaged
Covered (VIN) Cost New New ~~J)
Auto No. USED
1 ., l ~ "340FSS93S7' TKU"," W-350 ~ QUUUU tln.L MT 5
2 80 TRUeX FIRE 65000 WHITEHALL MT 5
W3ifOFS593571
3 80 i if TON TANKER 28000 WHITEHALL MT 5
if 82 ~lg~tf023if ~U W/PUMP 1T CREWCAB 20000 WHITEHALL MT 5
H CS15197
CLASSIFICATION
Radius of Business use Size GVW. Age Primary Secondary Code Except for towing. all physical damage
Operation s . service GCW or Veh Group Rating Rating loss IS payable to you and the loss
r . retail Seating Factor factor payee named below as interests
Covered c - commercial Capacity liab. Phy. may appear at the time of the loss.
Auto No. Oam. "
j I ~ ~~i l~
u 7' '7
COVERAGES-PREMIUMS, LIMITS AND OEDUCnBLES(Absenc~g~~ dedUCtl~\e or limit entry in any column below means that the limit
or deductible entrv In the corresoondlnQ ITEM 1WO column a les instead
L1ABIUTY PERSONAL INJURY PROTECTION ADDED P.I.P. PROP. PROTo Mich. onlv)
*L1mit Premium limit stated in each Premium Limit staled in each Limit stated in P.P.I, Premium
Covered P,J.P. End minus de- Added P.I.P. End. end. minus deduct
Auto No. ductible shown below Premium shown below
; lau ~~. :8'
] :8
Total 832. O~
Premium
COVERAGES-PR~~UMS, LIMITS AND DEDUCTlBLES(Absence of a dedUCti~l)e or limit entry in any column below means that the limit
or deductible en in the corTElSoondlna ITEM TWO column aODlies instead
CO'fered AUTO MED. PAY UNINSURED MOTORISTS UNINSURED MOTORIST UNDERINSURED MOTORISTS
PROPERTY DAMAGE
Auto No. *L1mit Premium "Limit Premium *Llmit Premium *limlt Premium
i i Itii lun l'J~
Tota! .-, ~.'- ---.. .- -"-=--~~-,~
Premium ' 61 .'00 55.00 . ...
COVERAGES-PREMIUMS, LIMITS AND DEOUCTlBLES(Absence of a dedUCti~l) or limit entry in any column below means that the limit
or deductible entry in the corresoondinQ ITEM TWO column aDolies instead
COMPREHENSIVE SPECifiED CAUSES OF LOSS COLLISION TOWING LABOR
Limit stated in ITEM Premium Limit stated in ITEM Limit stated in ITEM Premium Limit Per Premium
Covered TWO minus deduc. TWO TWO minus deduct Disablement
Auto No. tibIa shown below Premium shown below
~ i~ 6 :8 ~~8 U~J
~ :0
/ .0 ~o
Total 228.00
Premium 571.00
.(lIMITS SHOWN IN THOUSANDS)
p..~1to 3RD ~DlTION 12-11 E-tt PAGE 2 OF ,
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GALLATIN COUNTY FIRE PROTECTION MUTUAL AID AGREEMENT
SIGNATURE PAGE
Beaverhead Fire District #2
Dillon Rural Fire Department
Organization ~ -/
c5/R /;'57
.' C.... -
Chairman ~,-. t'~dt!# c::,-~'lc /~,d-~-?
Title -81gnature Date
City of Dillon
Organization
Mayor ~{l~ 3~~~P
Title ate
Sig ure
Organization
Title Signature Date
Organization
Title Signature Date
Organization
Title Signature Date
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* American Alternative Insurance Corporation
AAIC (A stock insurance company, herein called the Company; Incorporated under the laws of New York.)
Two ~orld Financial Center, 225 Liberty Street, New York, New York 10281
Telephone: 212-233-7769
Commercial General Liability
RENEWAL DECLARATION
POLICY NO. VFIS-CL-0001116-1jOOO
RENE~AL OF VFIS-CL-0001116-0
NAMED INSURED AND MAILING ADDRESS AGENCY AND MAILING ADDRESS
VFIS
DILLON RURAL FIRE DISTRICT #2 183 LEADER HEIGHTS ROAD
405 N IDAHO PO BOX 2726
DILLON MT 59725 YORK, FA 17405
POLICY PERIOO: From 07/01/97 to 07/01/98 AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOYN ABOVE.
GENERAL AGGREGATE 2,000/..000
PRODUCTS - COMPLETED OPERATIONS AGGREGATE ...2,000,000
PERSONAL INJURY & ADVERTISING INJURY 1;000,000
EACH OCCURRENCE l,OQO,OOO
FIRE DAMAGE 1,000,.000 ANY ONE FIRE
MEDICAL EXPENSE 5,000 ANY ONE PERSON
LOCATION OF ALL PREMISES YOU OWN, RENT OR OCCUPY:
LOC # 1: 405 N IDAHO, DILLON, BEAVERHEAD CO, MT
PMS PDTS
LOC CLASSIFICATION . PREMIUM BASIS RATE RATE
1 FIRE DEPARTMENTS - VOLUNTEER 4355 f AREA 8,000 61.071 INCL
PRODUCTS - W1PLETED OPERA T IONS ARESUBJECTTO JHE GENERAL. AGGREGATE L IMI T
2 FIRE DEPARTMENTS - VOLUNTEER 43551 AREA 2,400 61.071 INCL
PRODUCTS-COMPLETED OPERATIONS ARE SUBJECT TOTHEGENERALAGGREGATE LIMIT
PROFESSIONAL HEALTH CARE LIABILITY 72990 EACH 1 200.000
LIMITED POLLUTION & ASBESTOS LIABILITY 90100 EACH 1 95.000
I GENERAL LIABILITY PREMIUM $931 I
EXTRA COpy
GL1000A(01-96) 06-03-97 Page 3 of 4
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NUMllER: 1998-118
I COUNTY CONTRACT ROUTING FORlYl
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CONTRACT NAME ~,,-tA;. r~ ")0, L Vr 01 f ,-+c-" . 'Y' \ ,d,A ,1" n, ,I OcslIUU,"-/ .. ~'i 7
START DATE: 21 r.,jC;Y END DATE: Gis 0 /2CO-:- RENEWAL DATE: 3 '1'/) '{l,-,--,k"",'",_hc
RESPONSIBLE DEPARTMENT: CoLv\.J..,-h{ C')Y1^-AUS'-"'>1'-
\
NOTES/INSTRUCTIONS:
( / / / , / I '7 /f\
FISCAL OFFICER APPROVED: <;~~/ /") if .e,/ I '._,_r_ _ DATE:
c-
COUNTY AT!'ORNEY APPROVED: ).,U)- i k ~'\-' DATE: -z-llf/li&
- 'I -:>--- r
RETURNED TO RESPONSIBLE DEPAlrrMENT FOR OUTSIDE PARTY'S SIGNA-!1JRE: -..
SENTTO COMMISSIONERS FOR SIGNATURE: Mj11 (l/UUi/) ,,v-L'TCLuc..'t I ;2/ ( -7 Iii .~
FILE WITH CLERK & RECORDER: 2/17/98 CERTIFICATE OF INSURANCE RECEIVED: (' iA.~ <-b ,J h.1 1.1 I)L-
~>
"VHO SHOULD RECEIVE COpy OF COlVIPLETED CONTRACT?
(Check appropriate Offices)
CLERK AND RECORDER [ORIGINAL] FISCAL OFFICER
X RESPONSIBLE DEPARTMENT HEAL TH - NURSING
X COUNTY A TIORNEY HEAL TH - ENVIRONMENTAL
COUNTY COMM1SSIONERS REST HOME
ASSESSOR ROAD OFFICE
AUDITOR ~ C & R ACCOUNTING SHERIFF OFFICE
DES WEED DEPARTMENT
FACILITIES PERSONNEL
SEND DUPLICATE ORlGINALS TO:
INSURANCE COMPANY (Name):
Attention:
OTHERS (Include: Entity, Mailing Address, Phone #, and Contact Person)
DATE C & R DISTRIBUTED: 2/18/98
forms\contchk2 _ doc Jan_ 13, 1 <)97