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HomeMy WebLinkAboutMark Buck Construction, Inc. Certificate of Liability InsuranceOP ID N3 ACORD.. CERTIFICATE OF LIABILITY INSURANCE Bucxc-1 DATE (MM/DD/YYYY) 02/07 08 PRODUCER Western States Ins - Missoula P O Box 4386 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Missoula MT 59806 Phone: 406-721-1000 Fax: 406-721-9230 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Employers Mutual Casualty Co INSURER B: State Compensation Ins Fund Mark Buck Construction Iris. INSURER C: , 4900 Mallard Wayy Mi l 598 8 INSURER D: ssou a MT 0 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DDm E PDATE MM/DD Y ~N LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 , OOO , OOO A X COMMERCIAL GENERAL LIABILITY 3D38594 02/01/06 02/01/09 PREMISES (Eaoccurence) $100,000 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 5 , 000 PERSONAL & ADV INJURY $ 1 , 000 , 000 GENERAL AGGREGATE $ 2 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2 , O O O , 000 POLICY PRO LOC JECT AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT 000 1 000 A X ANY AUTO 3E38594 02/0],/0$ 02/01/09 (Ea accident) , , $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $2,000,000 A X OCCUR ~ CLAIMSMADE 3J38594 02/01/08 02/01/09 AGGREGATE $ 2, 000, 000 DEDUCTIBLE $ x RETENTION $10,000 $ WORKERS COMPENSATION AND X TORY LIMITS ER B EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE 033199977 02/01/08 02/01/09 E.L. EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 500 , 000 If yes, describe under -- SPECIAL PROVISIONS below _ -- _--- -- -------_-- ----_ E.L. DISEASE -POLICY LIMIT $ 500 , 000 A OTHER Property Section 3A38594 02/01/08 02/01/09 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Reference Project: East Wilson School Re-roof CERTIFICATE HOLDER CANCELLATION CITYOBO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION C1ty of Bozeman DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL l O DAYS WRITTEN Clerk of the COmmiSSiOn NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Fax#406-58 6-8470 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR P.O. Box 1230 BOZeman MT 59771 REPRESENTATIVES. AUTHORIZ REPRESENTATIV ~ / _ ACORD 25 (2001108) ©ACORD CORPORATION 1988