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HomeMy WebLinkAbout15- 2 Associated Pool Builders (Vaaler Insurance/Bismark) Certificate of LiabilityASSO-02 OP ID: RO '`%. � CERTIFICATE OF LIABILITY INSURANCE tv �� DATE /06120(MMIDD15 Y) 01/06/2015 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 endorsemen s . - PRODUCER Vaaler Insurance/Bismarck PO Box 933 Bismarck, ND 58502 NAME CT Rollin C. Mehlhoff PHONE FAX ac No En:701-258-2800INC, No: 701-258-2838 E-MAIL ADDRESS: rmehlhoff vaaler.com Rollin C. Mehlhoff 01/01/2015 01/01/2016 INSURE S AFFORDING COVERAGE NAICN INSURER A: American Casualty CO Of _ INSURED Associated Pool Builders Inc INSURERB:Continental Insurance Company 35289 etal. PO Box 2318 INSURER C:VaIIe Forge Insurance Co 20508 PRODUCTS - COMPIOP AGG $ 2,000,00 Bismarck, NO 58502 INSURER D: INSURER E: INSURER F: 05090912893 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 LTR TYPE OF INSURANCE A POLICY NUMBER MM/OD�F POUCYEXP MMIDDIYYYY LIMITS B X COMMERCIAL GENERAL LUIHILITY CLAIMS -MADE OCCUR X $500 Oce PD Ded $090912912 OFFSITE EXPOSURE ONLY 01/01/2015 01/01/2016 EACH OCCURRENCE S 1,000,00 PDREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 X per proj. agg. PERSONAL &ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER. POLICY DJEC LOC OTHER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMPIOP AGG $ 2,000,00 lEmp Ben. S IM/2111 C AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS 05090912893 01/01/2015 01/01/2016 COMBINED SINGLE LIMIT $ 1,000,00 Eaa cident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Peraccident A UMBRELLA UABX EXCESS LIAB OCCUR CLAIMS -MADE 05090912909 01/01/2015 01/01/2016 EACH OCCURRENCE S 5,000,60 X AGGREGATE $ 5,000,00 DED X I RETENTION$ 10000 IOFFSITE Is EXPOSURE B WORKERS COMPENSATION AND EMPLOYERS' LUIBIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICERIMEM13ER EXCLUOED4 (Mandatory in NH) If yes, descnbe under DESCRIPTION OF OPERATIONS below NIA EMPL LIAR ONLY (ND $ WY) SEE SEPT POLI FOR WC 01/01/2015 01/01/2016 PER OTH- STATUTE X ER E.L. EACH ACCIDENT $ 1,000,00 E. L. DISEASE - EA EMPLOYEE $ 1,000,00 E. L. DISEASE - POLICY LIMIT I $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) ctd Notes BOZEM-1 Bozeman City Clerk's Office City Hall Suite 102 PO 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 Rollin C. Mehlhoff © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD NOTEPAD A INSURED'$ NAME Associated Pool Builders Inc OPP ID: D: RO itional insured with waiver of subrogation applies respects general bility, auto and excess liability subject to terms and conditions of .pany's blanket endorsement arising out of your work for that itional insured if required by written contract or agreement. Primary, -contributory additional insured including completed operations applies contract requires. PAGE 2 Date 01/0612015