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HomeMy WebLinkAboutCogswell Insurance Agency, LLC Accor CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DDM(YY) 441....----- 7/26/2013 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(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 I CONTACT Laura Chouinard NAME:TA Cogswell Insurance Agency LLC I aH` r Frt,- (406)761-5000 I aC Nol: (406)453-3946 800 9th Street South ILorl5ss•lquintrell@cogswellinsurance.com P 0 Box 2009 I INSURER(S)AFFORDINGCOVERAGE NAIC# Great Falls MT 59403-2009 IINSURERA:EMC Insurance Companies INSURED INSURER B Montana State Fund Johnston Excavating Inc INSURERC: 805 Blackmore Place IINSURER D: I INSURER E: Bozeman MT 59715 IINSURER F: COVERAGES CERTIFICATE NUMBER:CL1372607947 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 AWL SUCK F'UUCY&:F POLICY tXP LTR I TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) IMM/DD/YYYY1 LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 UAMAUE TO RtN I ED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 500,000 A CLAIMS-MADE X OCCUR X 4X5-80-66 7/26/2013 7/26/2014 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 I GENERAL AGGREGATE $ 2,000,000 GENT.AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 X I POLICY F7 PE-°, n LOC $ AUTOMOBILE LIABILITY ECOMBINEDtSINGLE LIMIT I$ 1,000,000 A X ANY AUTO BODILY INJURY(Per person) I$ ALL OWNED SCHEDULED X 4X5-80-66 7/26/2013 7/26/2014 BODILY INJURY(Peracaden() $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) $ X UMBRELLA LIAB Unlnsured/Undennsured $ 1,000,000 OCCUR EACH OCCURRENCE IS 5,000,000 A EXCESS LIAB CLAIMS-MADE I AGGREGATE IS DED I IRETENTION S I X5-80-66 7/26/2013 7/26/2014 I I$ B WORKERS COMPENSATION WC STATU- NV. AND EMPLOYERS'LIABILITY Y/N I I TDR 1 IMITR I I FR ANY PROPRIETOR/PARTNER/EXECUTIVE I E L.EACH ACCIDENT S 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) 030929467 7/1/2013 7/1/2014 If yes,describe under E L.DISEASE-EA EMPLOYE $ 500,000 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ 5001 000 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if 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. ;ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF BOZEMAN CITY CLERKS OFFICE AUTHORIZED REPRESENTATIVE PO BOX 1230 BOZEMAN, MT 59771 Jennifer Mader/JM ` � 1 ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005)01 The ACORD name and logo are registered marks of ACORD