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HomeMy WebLinkAboutMontana Ready Mix Certificate of Liability Insurance with Allied Insurance Brokers AC o® CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDDlYYYY] 11128/2011 THIS CERTIFICATE IS ISSUED AS A ]NATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: _ Allied Insurance Brokers, Inc. P"c°N o AlCNc: Four Allegheny Center EMAIL S:Cert I in r kers.com Fourth Floor Pittsburgh PA 15212 INSURER(s)AFFORDING COVERAGE NAIC# INSURER A: ibert Insurance a ricers Inc 19917 _ INSURED 9396 INSURER B:Alter rance 2,961] Montana Ready Mix INSURER C jarnea_River Insurance Go. 122 209 East Cedar INSURER I7:Gemi i InsULanQe Compagy 1 33 Bozeman MT 59715 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:1910717311 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LTR INSR WVD POLICYNUMBER MMfDDNYYY) (MMIOD""I LIMITS D GENERAL LIABILITY Y VFGPOOI 153 /1172011 711112012 EACH OCCURRENCE $1,000,000 X OAMA Z TO RENTED COMMERCAL GENERAL LIABILITY PREMISES Ea oacunenm $50,000 _ CLAIMS-MADE TI OCCUR MED EXP(Any aria person) $Excluded PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG 52,000,000 X POLICY PRO- Lac $ A AUTOMOB[LELIABILITY GMIB006850111 !11!2011 !11!2012 Ea accident $1,000,000 ANY AUTO BOD14Y INJURY{Per person) S ALLOSWED X SCHEDULED BODILY INJURY(Per accfdent) 5 AUTOS HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ X JAUTOS Per accidert S C X UMBRELLA LIAB X OCCUR 000440961 /1112011 711112012 EACH OCCURRENCE 51,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 CFD RETENTION$ $ WORKERS COMPENSATION V4C STATU- I 111TH-1 AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVEâť‘ N!A E.L.EACH ACCIDENT RI 5 OFFICEMEMBER EXCLUDED? - (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ fyes,desolbe under DESCRIPTION OF OPERATIONS below F,L,DISEASE-POLICY LIMIT I$ B Riggers MAXA61M0041187 11172011 !1112012 Limit 260,000 Deductible 1,000 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) OVER THE ROAD coverage for mobile equipment:$1,000,000 bodily injury and property damage provided by General Liability.The below is named as an additional insured but only with respect to general liability and to the Covered operations of the named insured where liability for the additional insureds is assumed by the named insured under a written contract provided that the contract is executed prior to loss. PROFESSIONAL LIABILITY EXCLUDED. See Attached... CERTIFICATE HOLDER CANCELLATION30 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Bozeman ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 1230 Bozeman MT 59771 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 9396 _ LOC#: ADDITIONAL REMARKS SCHEDULE Page , of 1 AGENCY NAMED INSURED Allied Insurance Brokers, Inc. Montana Ready Mix 209 East Cedar POLICY NUMBER Bozeman MT 59715 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE 214 E Lamme-Bradley House ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD