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HomeMy WebLinkAbout2014 Certificate of Liability Insurance for High Country A CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 06/19/2014 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 00002-001 CONTACT NAME; PHONE NX,No: (406)234-3695 MVIS, LLC A/C No Ext: (406)234 3696 210 S Winchester Suite 430 EMAIL janell@mvisagency.com Miles City, MT 59301 RESse INSURERS AFFORDING COVERAGE NAIC/ INSURER A: Victory Insurance Company,Inc. INSURED INSURER B: High Country Paving, Inc. INSURERC: 5200 Thorpe Road INSURER D: Belgrade, MT 59714 INSURERE: 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 OF INSURANCE DDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERALLIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO ccu RENTED e $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PECT RO- LOC J AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea $ acd e ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ E UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPNSATIONAND EMPLO ERSELIABILITY LIMIT X WC OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE I,,llYY NN TORY LIMITS A OFFICER/MEMBER EXCLUDED? U N I WC100-0000477-2013A 9/24/2013 9/24/2014 E.L.EACH ACCIDENT E 1 000000 (Mandatory In NH) ������ E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) General Operations of the Insured. CERTIFICATE HOLDER CANCELLATION Bozeman City Clerk P.O. Box 1230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 121 North Rouse Ave City Hall, Suite 102 ACCORDANCE WITH THE POLICY PROVISIONS. Bozeman, MT 59771 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER COPY