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HomeMy WebLinkAboutAssociated Pool Builders Cert. of Liability InsuranceOP ID: JW CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DO/YYYY) TYPE OF INSURANCE 12/26/12 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 endorsements). PRODUCER 701- 258 -2800 Vaaler Insurance /Bismarck PO Box 933 701- 258 -2838 Bismarck, ND 58502 Rollin C. Mehlhoff CONTACT PHONE FAX PHONE E :e: AX No), EMAIL ADDRESS: PROUCER CUSTOMER ID p: ASSO -02 INSURERS AFFORDING COVERAGE INSURER A: Continental Casualty Company NAICIf 20443 INSURED Associated Pool Builders Inc Associated Builders, a Div. of APBI, Associated Supply Co. PO Box 2318 INSURER B: National Fire Ins of Hartford 20478 INSURER C: American Cas. Cc of Readinq PA EACH OCCURRENCE INSURER D: X Bismarck, NO 58502 INSURER E: MEDEXP(Anyonepemon) INSURER F : X PERSONAL SADV INJURY RCVIOIUN NURRULK: 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. HEIR TYPE OF INSURANCE L POLICY NUMBER MM POLICY SIT M /DDN1'x1'PY LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR $500 PD ded. 5090912912 PER OCC. 01101113 01/01114 EACH OCCURRENCE $ 1,060,00 X DAMAIET Ea occurrence) $ 100,00 MEDEXP(Anyonepemon) $ 5,00 X PERSONAL SADV INJURY $ 1,000,00 X [net XCU GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER POLICY FX P.Ror F I LOC PRODUCTS - COMP /OP AGG S 2,000,00 $ B AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON- OWNEDAUTOS 5090912893 01/01113 01/01/14 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Peraccident) $ $ A UMBRELLA LIAR EXCESS LIAR I X OCCUR CLAIMS -MADE N/A TND,WY 912909 912912 EMPL LIAB ON 01/01/13 01101113 01/01/14 01/01/14 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 DEDUCTIBLE X RETENTION $ 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBEREARTNERIE CUTIVE Y� (Mandatory in NH) Ky... describe under DESCRIPTION OF OPERATIONS below retention $ 10,00 WC STATU- OTH- E $ EL.EACHACCIDENT $ 1,000,00 E. L. DISEASE - EA EMPLOYEE S 1,000,00 E . DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) BOZEMA Bozeman City Clerk's Office City Hall Suite 102 PO Box 1230 Bozeman, MT 59771 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE _r_21UaL4_C� v T soo -cups AcU KU cUKYUKATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD �1 ACORO" OP ID: JW ��. CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YyyY) GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑OCCUR 12/28112 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 701- 258 -2800 Vaaler Insurance /Bismarck PO Box 933 701- 258 -2838 Bismarck, NO 58502 Rollin C. Mehlhoff CONTACT NAME: PHONE FAX % No Ext : A/C No), E -MgIL ADDRESS: PRODUCER CUSTOMER 10 p: ASSO -02 INSURERS AFFORDING COVERAGE INSURER A: Commerce and Indust Ins Co NAICR INSURED Associated Pool Builders Inc Associated Builders, a Div of APB[ NSURERB: MED EXP(Any one person) INSURER C: PO Box 2318 INSURER D: Bismarck, ND 58502 INSURER E : $ GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRO- LOC NSURER F $ C!N /CC/1 /_`CC __......_... _.- _.- .__... KtVI51UN 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. ILTR TYPE OF INSURANCE AODL SUP POLICY NUMBER MM /DU/Y1'EY1 V MM /DD/YY P LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑OCCUR EACH OCCURRENCE $ D A E RE PREMISES Ea ocwrrence $ MED EXP(Any one person) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRO- LOC PRODUCTS - COMP /OP AGO $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea aooiden) S BODILY INJURY(Per Person) $ BODILY INJURY(Per accident) S PROPERTY DAMAGE (Peraccident) $ $ A UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE NIA WC0999583 AKCO IA KS MN MT NE OK SD WI 01/01/13 01101/14 EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/RARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below WC SIAM U- OEH- X $ E. L. EACHACCIDENT $ 500,00 E.L. DISEASE -EA EMPLOYEES 500,00 E. L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Part 3 Other States Ins: AL AR AZ CA CT DC DE FL GA HI ID IL IN KY LA MA MD ME MI MO MS NC NH NJ NM NV NY OR PA RI SC TN TX UT VA VT MO MS NC NH NJ NM NV NY OR PA RI SC TN TX UT VA VT WI noorrcrnwr�,�n� non Bozeman City Clerk's Office City Hall Suite 102 PO Box 1230 Bozeman, MT 59771 M\ Urcu zo tcuuslusf BOZEM -1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 -2009 ACORD I17e ACORD name and logo are registered marks of ACORD All riahtc raeurvnd