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HomeMy WebLinkAbout15- Associated Pool Builders ,----.11 ASSO-02 OP ID: RO '..... `SCO o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDWYYY) • 12/30/2015 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 CONTNAME:ACT Rollin C.Mehlhoff Vaaler Insurance/Bismarck PO Box 933 PHONE FAX Ext):701-258-2800 (,v No): 701-258-2838 Bismarck,ND 56502 AIL ADDRESS:rmehlhoff@vaaler.com Rollin C.Mehlhoff INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:American Cas Co of Reading PA 20427 INSURED Associated Pool Builders Inc INSURER B:Transportation Insurance Co 20494 etaPOI Box 2318 INSURER C:Valley Forge Insurance Co 20508 Bismarck, ND 58502 • INSURER 0: INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 1 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 ADDL SUBR POLICY EFF POLICY EXP LTRMOD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY ' EACH OCCURRENCE $ 1,000,000 OAMAGE aReENTED CLAIMS-MADE X OCCUR 5090912912 01/0112016 01!01/2017 pREMISEs(Eaoceurrence)___$ '500000 $500 OCC PD Ded MED EXP(Any one person) $ *15000 X per proj.agg. PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO-JECT L J LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Emp Ben. $ 1M/2M AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 f (Ea accident) C X ANY AUTO C5090912893 01/01/2016 01/01/2017 BODILY INJURY(Per person) $ I. ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ -- HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A X EXCESS LIAB CLAIMS-MADE C5090912909 01/01/2016 01/01/2017 AGGREGATE $ 5,000,000 �� DED X RETENTION$ 10000 $ WORKERS COMPENSATION PER 0TH- AND EMPLOYERS'LIABILITY STATUTE X ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N EMP LIAB ONLY ND WY 0110112016 01/01/2017 E.L.EACH ACCIDENT $ ,000,000 OFFICER/MEMBER EXCLUDED? N/A -"1 (Mandatory in NH) SEE SEP POLI FOR WC E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $ 1,000,000 1 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space Is required) otd Notes ) CERTIFICATE HOLDER CANCELLATION U BOZEM-1 E SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I) THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Bozeman City Clerk's Office ACCORDANCE WITH THE POLICY PROVISIONS. City Hall Suite 102 AUTHORIZED REPRESENTATIVE PO Box 1230 ) Bozeman,MT 59771 � � )OLp.-p hr I ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD , ASSO-02 PAGE 2 NOTEPAD INSURED'S NAME Associated Pool Builders Inc OP ID: RO Date 1 2/3 012 01 5 Additional insured with waiver of subrogation applies respects general liability, auto and excess liability subject to terms and conditions of company's blanket endorsement arising out of your work for that additional insured if required by written contract or agreement. Primary, non-contributory additional insured including completed operations applies IF contract requires. SUBJECT TO TERMS AND CONDITIONS OF POLICY FORM AND ENDORSEMENTS • III