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�� CERTIFICATE OF LIABILITY INSURANCE
DATE (MMfDDNYYY)
04/03/2024
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(les) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terns 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 endorsements).
PRODUCER
NAME: Chris Larsen
Chris Larsen
6275 N Linder Rd Ste 120
PHONE 208IF
-89$-$$48 'AX No
E-MAIL ADDRESS: clarSen Idfbins.com
INSURERS AFFORDING COVERAGE
NAIC 0
Meridian, ID 83646
INSURERA: Western Community Insurance Company
39519
ID
INSURED
INSURER B
Dee Bailey
INSURER C :
PO BOX 967
INSURER D :
Nampa, ID 83653
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMRFR:
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.
tLTR
TYPEOFtNSURANCE
ADDL
POLICYNUMBER
MOLDIpYEFF
POLIY
MMFDDN XP
LIMITS
A
X
COMMERCIAL GENERALLIABILITY
CLAIMS -MADE a OCCUR
Y
N
8MT54001
04/23/2024
04/23/2025
EACH OCCURRENCE
S 500,000
PREMISES Eaoocurrence
S 100,000
MED EXP (Any one person)
S 5,000
PERSONAL d ADV INJURY
s 500.000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY ❑ JE T LOC
OTHER:
GENERAL AGGREGATE
S 1.000,000
PRODUCTS - COMPIOP AGG
S 1,000,000
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
COMBINED SIN LE LIMIT
Ea accident
S
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
S
PROPERTY DAMAGE
Per aaitlenl
$
$
A
UMBRELLA LIAB
EXCESS LIAR
OCCUR
CLAIMS -MADE
EACHOCCURRENCE
$
AGGREGATE
$
DED I RETENTIONS
$
WORKERS COMPENSATION
ANDEMPLOYERS'LIABILITY YIN
ANYPROPRIE70PJPARTNERIEXECUTIVE
OFFICERfMEMBEREXCLUDED? ❑
(Mandatory In NH)
tt yes, desaibe under
DESCRIPTION OF OPERATIONS below
N f A
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
E
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddMonal Remarks Schedule, may be attached If more space Is required)
Proof of General Liability for hangar at 5125 Aviation Way #803
CERTIFICATE HOLDER CANCFI I ATInNi
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Caldwell
ACCORDANCE WITH THE POLICY PROVISIONS.
4814 E Linden St
AUTHORIZED REPRESENTATIVE
Caldwell, ID83605
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