HomeMy WebLinkAbout2009 09 16 Workers Comp Certificate of Coverage for Library at Raptor FestCERTIFICATE OF WORKERS’
COMPENSATION COVERAGE
ISSUE DATE (MM/DD/YY)
September 16 , 2009
POOLED RISK RETENTION GROUP
MONTANA MUNICIPAL INTERLOCAL
AUTHORITY (MMIA)
PO BOX 6669
HELENA, MT 59604 -6669
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 MEMORANDUM OF COVERAGE.
PH: (406) 443 -0907 FAX: (406) 449 -7440 TYPE OF COVERAGE
COVERED PARTY
City of Bozeman Workers’ Compensation
PO Box 1230
Bozeman MT 59771 -1230
COVERAGES
THIS IS TO CERTIFY THAT A MEMORANDUM OF COVERAGE HAS BEEN ISSUED TO THE COVERED PARTY NAMED ABOVE FOR THE POLICY PERIOD INDIC ATED.
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 COVERAGE AFFORDED BY THE MEMORANDUM IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH MEMORA NDUM.
TYPE OF COVERAGE POLICY NUMBER POLICY EFFECTIVE
DATE (MM/DD/YY)
POLICY EXPIRATION
DATE (MM/DD/YY)
STATUTORY LIMITS X
WORKER S’COMPENSATION 1017WC 07/01/09 07/01/10 EACH ACCIDENT
DISEASE -POLICY LIMIT
DISEASE -EACH EMPLOYEE
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
CERTIFICATE HOLDER CANCELLATION
Bridger Bowl Inc.
15795 Bridger Canyon Road
Bozeman MT 59715
SHOULD ANY OF THE ABOVE DESCRIBED COVERAGES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE MMIA WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE MMIA,ITS AGENTS OR REPRESENTATIVES .
AUTHORIZED REPRESENTATIVE