HomeMy WebLinkAboutMontana Ready Mix Certificate of Liability Insurance Client#:4379 MTREADYM
ATE
ACORD. CERTIFICATE OF LIABILITY INSURANCE D11/28/2011(MWDDtYYYY)
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 NAME Lisa Greenwood
Hoiness LaBar Insurance PHONE 406-238-1900 406-532-5800
A Member of Payne Financial Group E- AIL Ext: AlC,No:
ADDRESS: [greenwood@pfg-insurance.com
P.O.Box 30638
CUSTOMER ID M:
Billings,MT 59107-0638 INSURER(S)AFFORDING COVERAGE NAIC 0
INSURED INSURER A:Liberty Northwest
Montana Ready Mix,L T D
INSURER B
209 E Cedar
Bozeman,MT 59715 INSURER C:
INSURER D:
INSURER E
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 CONTRACTOR OTHER DOCUMENT WITH RESPECTTO 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.
IN SR TYPE OF INSURANCE DDL U R POLICY EFF POLICY EXP
LTR N D POLICY NUMBER MWDD NYYY) JUM22NYYYL LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY DAMAGE TO RE ED
PREMISES Ea Occurrence)$
CLAIMS-MADE 7 OCCUR MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGG $
POLICY PRO- LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S
(Ea accident)
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED AUTOS
BODILY INJURY(Per accident) $
SCHEDULED AUTOS
PROPERTY DAMAGE $
Hl RED AUTOS (Per accident)
NON-OWNED AUTOS 5
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE AGGREGATE S
0EDUC7IRLE g
RETENTION $
A WORKERS COMPENSATION WC41 NC015029011 1/01/2011 01/01/2012 X WC STATU- o7z1-
AND EMPLOYERS'LIABILITY YIN
ANY PFiOPRIETORIPARTNERlEXECUTIVE� N/A
E.L.EACH ACCIDENT $1,000,000
OFFICERVMEMBER EXCLUDED? - -
(Mandatory In NH) E.L.DISEASE-EA 1=MPLOYEE $1,UOU,OOD
11 yS,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 51,000,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach ACORD 101,Addlllonal Remarks Schedule,if more space Is required)
**Workers Camp Information**
Proprietors/Partners/Executive Officers/Members Excluded:
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
City of Bozeman SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
P.O.BOX 1230 ACCORDANCE WITH THE POLICY PROVISIONS.
Bozeman,MT 59771
AUTHORIZED REPRESENTATIVE
@1988-2009 ACORD CORPORATION.All rights reserved.
ACORD 25(2009109) 1 of 2 The ACORD name and logo are registered marks of ACORD
#S707556/M594432 LG1
DESCRIPTIONS (Continued from Page 1)
Melinda Poncelet,VP Sec Treas
214 B.Lamme-Bradley House
AMS 25.3(2009109) 2 Of 2
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