HomeMy WebLinkAboutTownsend Backhoe Services for Street Project TOWNS-2 OP ID: JM
CEI I F IC A T F L.I I IT`Y I S DATE(MMfDDIYYYY)
0313'112014
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 at such endorsement(s).
PRODUCER CONTACT
Phone:406-587W5111 NAME: Jana McMillan
First West,Inc. Fax:406-587-9162 PHONE 406-922-6024 FAx 406-587-9162
PO BOX 1$00 IARC.No,Extl: A1C No
1905 Stadium Drr I-MAIL
Bozeman,MT DADDRESS:Jana fstwest.com
Bryan D.Hall,CIC INSURERS AFFORDING COVERAGE NAIL#
INSURER A;Cincinnati Insurance Company 10677
INSURED Townsend Backhoe Service,Inc. INSURER B:
170 Joes Way
Bozeman, MT 59718 INSURER c
INSURER 0:
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 7woqTYPE OF INSURANCE S POLICY EFF POLICY EXP ��
LTR POLICY NUMBER MMIDI'NYYYY MMIDDfYYYY LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,00 '
A X COMMERCIAL GENERAL LIABILITY X EPP0023210 05/0412013 05104/2014 PREMISES Ea oeeurrence $ 500,1}0(}
CLAIMS-MADE � OCCUR MED EXP(Any one person) $ 10,00
PERSONAL S ADV INJURY $ 1,000,00
GENERAL AGGREGATE $ 2,000,00
GFNT AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPIOP AGG $ 2,000,00..
1-1 POLICY X IPRO- LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000 000
Ea acadent $ ,
A X ANY AUTO EBA 0023210 0510412013 0510412014 BODILY INJURY{Per person) S
ALL OWNED SCHEDULED BODILY INJURY Per accldenl $
AUTOS AUTOS ( )
NON-OWNED PROPERTY DAMAGE
HIRED AUTOS AUTOS Per accident
$
}( UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 1,000,000
A EXCESS LIAR CLAIMS-MADE EPP0023210 0510412013 0510412014 AGGREGATE $ 11000,00..
DED X I RETENTION$ 0 $
WORKERS COMPENSATION WC STATU- 0TH-
AND EMPLOYERS'LIABILITY YIN TORY LP:uRIT ER _e
ANY PROPRIETORFPARTNERIEXECUTIVE ❑ E.L.EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED? NIA
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
. I(ycs,deacrsbe under
DESCRIPTION OF OPERATIONS Below E.L.DISEASE-POLICY LIMIT $
A Leased/Rented EPP0023210 05/0412013 05104/2014 Limit 450,000
Equipment Ded 11000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it more space is required)
Certificate holder is additional insured for General Liability, provided
requirement is part of a written agreement currently in effect, per
conditions and limitations of policy form GA233MT 05-10 available upon
request.
CERTIFICATE HOLDER CANCELLATION
CITYBI5
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.
Street Department AUTHORIZED REPRESENTATIVE
PO Box 1230
Bozeman, MT 59771-1230 "
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ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD