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DATE IMM1DDrYYYY)
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CERTIFICATE OF LIABILITY INSURANCE 11109112
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE.DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed.. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER 406_388-4228 CONTACT
NAME.
Central Insurance Agency 406-388-4229 PHONE - FAx
151 W.Madison evc No Ex� _- _. .. _.._...._. (A/C,No)�
PO Box 1170 EMAIL -
Belgrade,MT 59714 ADDRESS:
Traci Waddell CUSTOMER ID#:WILLI-4
IN5URER(5)AFFORDING COVERAGE NAtC#
INSURED Williams Plumbing and INSURERA.Allied Insurance Company 00035
Heating Inc INSURER B
P O Box 10
Bozeman, MT 59771 INSURER c
INSURER D
ENSURER E:.
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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.
—__ ...w. ..., ... ... .- -
I4.TIR ,.. TYPE OF yN3URANCE. _...-..... AD DL G INqR Sl3F _ ........
.. ........... .POLICY NUMBER I.,MOLICY EFF POLICYr'YYY LIMITS
GENERAL LIABILITY '
EACH OCCURRENCE $ 2,000,000
A II X COMMERCIAL GENERAL LIABILITY X ACP751477 IJAMAGLTO RENTED
1658 12131111' li 12131/12 PREMISES(Ea cecurrenceL 100,00
I
CLAIMS-MADE ..., ..., OCCUR I MED EXP(Any one person) $ ...._ -, ,00
10,00
GENERAL AGGREGATE
INJURY S 4,000,0
a00
POLICY i e m �� LOG
PRODUCTS-COMP1aP AGG $ 4,000,00
..._ --
GENLAGGRE�LIMITAPPI.YESPFR �
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
A (Ea accident) $ 1 r000,0(1R"
AuT ANY AUTO ACP7514771658 12131/11 12/31/12 ....... ..._....... -
BODILY INJURY(Per person) $
ALL OWNED AUTOS h.._.m_.,.,_®
j BODILY INJURY(Per accident) $
_.._.
SCHEDULED AUTOS ...
PROPERTY DAMAGE $
HIRED AUTOS
(Par accident)
�
NON AUTOS
I
w
,
UMBRELLA LIAR EACH OCCURRENCE $ 4,000,00
X , X OCCUR
EXCESS LIAB CLAIMS MADE AGGREGATE S 4,000,00
,y -.—� ......., `ACP7514771658 12/31/11 12131/12 ___. . _.m_.
_ DEDUCTIBLE ! l�. . ........ ........ I$
X _ _.....
� RETENTION S 0 �,
I WORKERS COMPENSATION YIN
_6VC STATU- I 1 OTH.
OFFICERP RIETC R EXCLUDED')RTNER NIA
, 1 E L EACH ACC
�7 ..L.11ITS�
ANY PROPRIETCRPPARTNERlEXECUTIVE NT. Is
(Mandatary in NH) E.L.DISEASE EA EMPLOYEE $
If yes,describe unmet i f
——
DESCRIPTION OF OPERATIONS below IF L DISEASE-POLICY LIMIT ( $
A Leased/Rented I ACP7514771658 12131/11 12131112 I 1,000,000
Equipment
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required)
RE: 2012 Christmas Party at Story Mansion
The certificate holder is listed as an additional insured as
Itheir interests may appear with respects to operations of the
named insured.
CERTIFICATE HOLDER CANCELLATION
CITYBBO
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Bozeman,State of MT ACCORDANCE WITH THE POLICY PROVISIONS.
Its Officers,Agents and
AUTHORIZED RE RESENTATiVE
Employees Traci Waddil I
PO Box 1230
Bozeman MT 59771 ,...
0 1988-2005 ACORD CORPORATION. All rights reserved.
ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD