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HomeMy WebLinkAbout15- High Country Paving, Inc (Central Insurance Agency) Certificate of LiabilityHIGHC-7 OP ID: TW CERTIFICATE OF LIABILITY INSURANCEATE /Y) P06/22/2015 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 Central Insurance Agency 161 W. Madison PO Box 1170 Belgrade, MT 59714 CONTACT PHONE FAX A/c No Ext): A/C, No): EMAIL ADDRESS: GENERAL LIABILITY Mark Roemer, CIC INSURERS AFFORDING COVERAGE NAIC # INSURERA: United Fire Group INSURED High Country Paving, Inc 5200 Thorpe Rd Belgrade, MT 59714 INSURER B : INSURERC: X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X INSURER D: INSURER E: 08/01/2014 INSURER F: DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 COVERAGES CERTIFICATE NUMBER: RFVISRInN NI IMRFrr- 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 LTR TYPE OF INSURANCE ADDL SUB POLICY NUMBER MM/POLDDfYCY YYY MM/DDNYPOLICY YY LIMITS Bozeman, MT 59771 GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X 60436013 08/01/2014 08/01/2015 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,00 PERSONAL RADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: —1 PRODUCTS - COMP/OP AGG $ 2,000,000 PRO -LOC POLICYFX] JECT $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY (Per person) $ A X ANY AUTO X 60436013 08/01/2014 08/01/2015 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ ( ) NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ PER ACCIDENT X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS -MADE X 60436013 08/01/2014 08/01/2015 AGGREGATE $ 2,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. OFFICER/MEMBER EXCLUDED? N / A TORY LIMITSI ER EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Leased/Rented 60436013 08/01/2014 08/01/2015 100,000 Equipment Ded. $500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: 2015 Street Improvements. The certificate holder is listed as an additional insured as their interests may appear with respects to the operations of the named insured. This includes products and completed operations CERTIFICATE HOLDER rANrFl I ATInKI CITYBBO 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. City Clerks Office AUTHORIZED REPRESENTATIVE PO Box 1230 Bozeman, MT 59771 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD HIGHC-7 OP ID: TW CERTIFICATE OF LIABILITY INSURANCEATE 06/22/2015 ) 06/22/2015 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 Central Insurance Agency 161 W. Madison CONTACT NAME: PHONE FAX A/c No Ext): A/C No): PO BOX 1170 Belgrade, MT 59714 E-MAIL ADDRESS: Mark Roemer, CIC INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: United Fire Group INSURED High Country Paving, Inc 5200 Thorpe Rd Belgrade, MT 59714 INSURER B: INSURER C X INSURER D: INSURER E: 08/01/2015 INSURER F: . MED EXP (Any one person) $ 5,000 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 TR TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDY YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X 60436013 08/01/2014 08/01/2015 DAMAGE TO RENTED 100 000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY X PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 000 Ea accident $ ,00 BODILY INJURY (Per person) $ A X ANY AUTO X 60436013 08/01/2014 08/01/2015 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ PER ACCIDENT X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 A EXCESS LIAB CLAIMS -MADE X 60436013 08/01/2014 08/01/2015 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A Leased/Rented 60436013 08/01/2014 08/01/2015 100,000 Equipment Ded. $500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: 2015 Street Improvements The certificate holder is listed as an additional insured as their interests may appear with respects to the operations of the named insured. This includes products and completed operations CITYB-7 City of Bozeman Engineering Department P O Box 1230 Bozeman, MT 59771 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 4,-N� W ao�� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD