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RECEIVED o 3 199*
At~ttlll.~ ,'CERTIFICAl1!.'OF.:INSURANCE " IS$UE DATE (MM/DD/YY)
i
PRODUCER THI
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE I
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
..~_._._______'__'___.._ .. .__..,.___".,._." ....__...___.._."".,, _.~",'_._,._.".~___,_~ ...__n' " ._."__~."',_,,,..,,,"."" .
COGSWELL. AGENCY COMPANIES AFFORDING COVERAGE
BOX 200\71
GF~E('.'T F-~' A I... L. !;~; t'IT 59403 f~T~~NY A
AMER I C(.,)N STATES ING
INSURED f~T~~NY B
I BOZEIVIAN LITTLE L.E(.~GUE f~T~~~NY C
I p 0 BOX i:?OE3S{~. f~T~~~NY D
BIL.L.INGS MT 5910Ll.
f~T~~NY E
COVERAGES
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.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE (MM/DDIYY) DATE (MM/DD/YY)
{lJ GENERAL LIABILITY o 1 CC8333'~.640 2/:l.5/9t,J. 2/:1. S/9S GENERAL AGGREGATE ~?OOO?OOO
X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $J.,OOO,OOO
CLAIMS MADE X OCCUR, PERSONAL & ADV. INJURY l,OOO,OOO
OWNER'S & CONTRACTOR'S PROTo EACH OCCURRENCE \,000,000
FIRE DAMAGE (Anyone firo) 50,000
MED, EXPENSE (Anyone person) if:), 000
AUTOMOBILE LIABILITY COMBINED SINGLE
LIMIT $
ANY AUTO
ALL OWNED AUTOS BODILY INJURY
(Per person) $
SCHEDULED AUTOS
HIRED AUTOS BODIL Y INJURY
(Per accident) $
NON-OWNED AUTOS
GARAGE LIABILITY
PROPERTY DAMAGE $
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM
STATUTORY LIMITS
WORKER'S COMPENSATION
EACH ACCIDENT $
AND
DISEASE-POLICY LIMIT $
EMPLOYERS' LIABILITY
DISEASE~EACH EMPLOYEE $
.'----....~
OTHER
,
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DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS
FOH PROOF OF INSUR(.~NCE ONL. Y
CERTIFICATE HOLDER CANCELLATION --
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO t
MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
C l"rV OF BOZEMAN LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVE ,
f..1.1 :I Ef..'f.;T M(.UN EiTHEFT AUTHORIZED REPRESENTATIVE
F:OZEM(..)N t'IT S971 ~; C/)
E B COGSWELL.
ACORD 25-S(7/90)