HomeMy WebLinkAboutAssociated Pool Builders Inc. Commerce and Industry Ins Certificate of Liability Insurance ASSO-02 OP ID:JW
71T,2112412013(MMIDDYYYY)
CERTIFICATE OF LIABILITY INSURANCE
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 Phone:701-258-2800 NAME: T
., _...— ._.
Vaaler Insurance/Bismarck —
..._
PO Box 933 Fax:701-258-2838 [dGNN Ertl: _..... .. N�=_.._... _...
Bismarck,ND 56502 E-MAIL _.m
Rollin C.Mehlhoff ADDRESS: ........
INSURERS)AFFORDING COVERAGE NAIL#
_ INSURER A Commerce and Industry Ins Co
INSURED Associated Pool Builders Inc - INSURER B:
Associated Builders,A Div. of _ _................. _. . ....
APBI INSURER C
PO Box 2318 INSURER D
Bismarck, ND 58502 INSURER 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.
INSR ._..............
TYPE INSURANCE ADDL BR — _POLICY EFF POLICY EXP _ ...._.....w..._.
LTR TYPE OF INSURANCE POLICY NUMBER MMIDD[YYYY MMdDDlYYYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
.. ..........
REN
DACE Ti5 TE[S
COMMERCIAL GENERAL LIABILITY PREMISES(Ea accumence $
CLAIMS-MADE E] OCCUR MED EXP(Any one person) _ $
PERSONAL&ADV INJURY $
''..... GENERAL AGGRI•=GATE $
GEN"L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $
POLICY D PRO LOC $
AUTOMOBILE LIABILITY COMBINED S#NGLE LIMIT
.. `Leccidenl J
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS jPex acdenl)..... ...._..... _
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS MADE AGGREGATE $
DED I I RETENTION$
WORKERS COMPENSATION X I WC STATU- OTH-
AND EMPLOYERS'LIABILITY YIN NIA ... ...T_QRY...L.IMIT ER „_.....
A ANY PROPRIETORIPARTNERlEXECUTIVE WC0999583 AK CO 01101/2014 01/01/2015 E.L.EACH ACCIDENT $ 500,00'
OFFICERrMEMBER EXCLUDED. ® — ..--............ ._,..,_...., .m_...........
(Mandatory in NH) IA KS MN MT NE QK DWI E.L.DISEASE-EA EMPLOYEE $ 500,00
If yes,descritbe under - —
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,Ir more space is required)
Part: 3 Other States Ins: AL AR AZ CA CT DC DE FL GA HI ID IL IN ICY LA MA. MD
ME MI MO MS NC NAT NJ NM NV NY OR PA RI SC TN Tx UT' VA VT
MO MS NC NH NJ NM NV NY OR PA RT SC TN TX UT VA VT WY
CERTIFICATE HOLDER CANCELLATION
BOZEM-1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Bozeman'City Clerk's Office ACCORDANCE WITH THE POLICY PROVISIONS.
City Hall Suite 102
PO Box 1230 AUTHORIZED REPRESENTATIVE
Bozeman,MT 59771
Q 1988-:2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD