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HomeMy WebLinkAboutHigh Country Paving, Inc. Certificate of Liability Insurance AC COR CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYYY) `..----- 09112/2014 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). CNTACT PRODUCER 00002-001 NAME: MVIS, LLC (Arc. HONE 406)234-3696(406)234-3696 1FA/CC.No): (406)234-3695 210 S Winchester Suite 430 InFnl@Anss: jaemvisagency.com Miles City, MT 59301 INSURER(S)AFFORDING COVERAGE _ NAIC t/ INSURER A:_ Victory Insurance Company,Inc. INSURED (INSURER B: High Country Paving, Inc. INSURER c 5200 Thorpe Road INSURER D: Belgrade, MT 59714 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 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. INTR I TYPE OF INSURANCE ADD'S l 0 POLICY NUMBER POLICY EFF POLICY EXP LIMITS (M MIDD/YYYY1 IMM/DD/YYYYI. GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES(Fa occurrence) _ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER' I POLICY PRODUCTS-COMP/OP AGG $ n PRO- I LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident! ANY AUTO I BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS I BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED I PROPERTY DAMAGE $ AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE i AGGREGATE $ DED I I RETENTION $ I $ --- --- — WORKERS COM PENSAT.OI WC STATU- 0TH- AND EMPLOYERS'LIABILITY X I TORY LIMITS( ER I ANY PROPRIETOR/PARTNER/EXECUTIVE YIN I E.L EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? N I N I A 1 WC100-0000477-2014A 9/24/2014 9124!2015 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL-DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES Attach ACORD 101,Additional Remarks Schedule,If more space is required) General Operations of the Insured. CERTIFICATE HOLDER CANCELLATION Bozeman CityClerk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE P.O. Box 1230230 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 121 North Rouse Ave City Hall, Suite 102 ACCORDANCE WITH THE POLICY PROVISIONS. Bozeman, MT 59771 AUTHORIZED REPRESENTATIVE --cac— l- 7c :cam.-„-1/4..__, ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER COPY