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HomeMy WebLinkAbout15- 1 Associated Pool Builders (Vaaler Insurance/Bismark) Certificate of LiabilityASSO-02 OP ID: RO ,acoRO" CERTIFICATE OF LIABILITY INSURANCE L.� DATE 01/061201LMMIDDtYYY) 01 /0 61201 5 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(]es) 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 Vaaler Insurance/Bismarck PO Box 933 Bismarck, ND 58502 CONTANAME: Rollin C. Mehlhoff PHONEFAX o Ea:701-258-2800 ac Nn: 701-258-2838 Ac Ne. E-MAILADDRESS: rmeh[hoff@vaaler.com Rollin C. Mehlhoff Rollin C. Mehlhoff INSURERS AFFORDING COVERAGE NAIC M INSURERA: Commerce and Industry Ins Co INSURED Associated Pool Builders Inc INSURERB: eta]. PO Box 2318 INSURER C: Bismarck, NO 58502 INSURER D: INSURER E DAM E T�Ep PREMISES Ea occurtence $ 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. MSR R TYPE OF INSURANCE AbSD SUB POLICY NUMBER LICY EFF MMIDDY /YYYY POLICY EXP MNV D/YYYY LIMITS PO Box 1230 COMMERCIAL GENERAL LIABILITY Rollin C. Mehlhoff Bozeman, MT 59771 EACH OCCURRENCE $ CLAIMS-MADE1:1 OCCUR DAM E T�Ep PREMISES Ea occurtence $ MED EXP (Any one person) $ PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY [:] PRO ❑ LOC ECT PRODUCTS-COMP/OP AGG S $ OTHER: AUTOMOBILE LIABILITY CEa accOMB IN ED S INGLE LIMIT ident $ BODILY INJURY (Per person) $ ANY AUTO _ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Perawident NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION$ S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE Y� WC0999583 AK, CO, IA, KS 01101/2015 01101/2015 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA MN, MT, NE, OK, SD, WI EL.DISEASE -EA EMPLOYEE $ 500,00 If yes, describe under DESCRIPTION OF OPERATIONS below E . DISEASE- POLICY LIMIT S 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Part 3 Other StatesAL AR AZ CA CT DC DE FL GA HI ID IL IN KY IA MA MD ME MI MO MS NC NH NS NM NV NY OR PA RI SC TN TX UT VA VT WI; Blanket Sub waiver CERTIFICATE HOLDER CANCELLATION BOZEM-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Bozeman City Clerk's Office City Hall Suite 102 PO Box 1230 AUTHORIZED REPRESENTATIVE Rollin C. Mehlhoff Bozeman, MT 59771 ACORD 25 (2014/01) ©1988.2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD