HomeMy WebLinkAboutJohnston Excavating Inc. Emc Insurance Co., MT State Fund, Zurich Small Business Certificate of Liability Insurance AC"REP`
-'+ DATE(MMIDDPYY)
CERTIFICATE LIABILITY 6/14/2013
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(les)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 NAPNAEA Laura Chouinard
Cogswell Insurance Agency LLC PHONE (406)761--5000 FAIL P AS3-394fi
Ali(', No!,800 9th Street youth E-MA1� „lquintrell @cogswellinsurrance.cc"m
P O Box 2009 INSURERS AFFORDINGCOVERAGE NAIC#
Greet Falls MT 55403-2009 INSURERA:EMC Insurance Com anies
INSURED INSURER B Montana. State Fund
LTohnston. Excavating Inc INSURER c:Zurich Small Business
805 Blackmore Place INSURER D:
INSURER E:
Bozeman MT 59715 INSURER F
COVERAGES CERTIFICATE NUMBER:CL1272507300 REVISION NUMBER:
THIS 1S 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 AD DL SUBR
LTR TYPE OF INSURANCE POLICY NUMBER MMIDD1 EYYY MMIDDNY P LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ 500,000
A CLAIMS-MADE I X l OCCUR X Y 4X5-80-66 ✓2�/2D12 /26/2013 MED EXP(Any one person9 $ 10,000
PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER. .....PRODUCTS-COMPIOPAGG '.,3 2,000,000.
X POLICY PRO- LOG $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Eaaccidenl 1,000,000
A X ANY AUTO BODILY INJURY(Per Person.)
ALL AUTOSULED X X5-80--66 /26/201,2 /26/201.3 BODILY INJURY(Peraccident)
NON-OWNED
HIRED AUTOS AUTOS PROPERTY DAMAGE $
Per accident
Uninsured/Underinsured $ 1, 00,000
X EXCESS LAB OCCUR EACH OCCURRENCE $ 5,000,000
A EXCESS LIAB CLAIMS-MADE
FJ
AGGREGATE $
DED RETENTION$ 3�5 80-55 /2G/2012 /26/2013
$
B WORKERS COMPENSATION' V1dC STATU- OTH-
AND EMPLOYERS'LIABILITY
ANY PROPRIETOWPARTNERIEXECUTIVE YIN 000
'.OFFICEWMEMBEREXCLUDED? NIA E.L.EACH ACMDENT $ 500
(Mandatory in NH) 30929467 / f 2013 /1./2014`" FL 01SEASE_EgEMPLOYE S 500,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ S00 000
C Builders Risk EC04375715 /2/2012 /2/2013 471,232
Deductible 1,000
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101.,Additional Remarks Schedule„It more space Is required)
CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED PER FORM CG 7482.3 & CA 7270. WAIVER OF SUBROGATION IN
FAVOR OF CERTIFICATE HOLDER PER FORM CG7555. NOTICE OF CANCELLATION HAS BEEN CHANGED TO 45 DAYS-PER FORM
7338, GL INCLUDES CONTRACTUAL LIABILITY PER FORM CG 00 01 12 07. PLEASE REFER TO SECTIONS 1.2.b & V.9.f
FOR CLARIFICATION OF CONTRACTUAL LIABILTIY COVERAGE,
CERTIFICATE HOLDER CANCELLATION
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.
CITY CLERKS OFFICE
PO BOX 1230 AUTHORIZED REPRESENTATIVE
BOZEMAN, MT 59771
Laura Chouinard/LQ
ACORD 25(2010105) 071988-20"10 ACORD CORPORATION. All rights reserved.
INS025(201005).Ol The ACORD name and logo are registered marks of ACORD