HomeMy WebLinkAboutRichard BugatchAliCOD I*
CERTIFICATE OF LIABILITY INSURANCE
DATE(MMf)DNYYY)
�
2/07/2024
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: It the certificate holder is an ADDITIONAL INSURED, the policy((es) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain pollcies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER
CONTACT
NAME; ROBERTS CYNTH I A
PHONE 208-888' 1821 Fare No . 208 232-3sos
Western Community Ins Co
PO Box4848 IZ i1 3 %02ri
ADD RESS:
INSURER(SI AFFORDING COVERAGE
NAICS
Pocatello, ID 832054848
INSURER A : Western Community Ins Co
39519
INSURED
1111111111lIIIIIIIIIttI1t11111111tI11111111111111111
INSURER B :
BUGATSCH RICHARD B
INSURERC:
INSURERD:
HOUSTON DOUGLAS
INSURER E :
5g08 S PINE ST
AAMPA ID 83686
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:AF0670
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
TYPE OF INSURANCE
ADDLSUBR
POLICY NUMBER
MMI�O1YCY YYY
MMIpp�Y
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO R4NI
PREMISES (Ea occurrence)
MED EXP (Any one person)
S 100,000
$ 5 , 000
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE J[p OCCUR
A
N
N
8G2616o 1
3/02/24
3 f 02/25
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
S 2,000,000
PRODUCTS - COMP/OP AGG
$ INCLUDED
GEN'L AGGREGATE LIMIT APPLIES PER,
)( POLICY PRO- LOC
$
AUTOMOBILE
LIABILITY
I E SINGLE LIMIT
Ea accident
S
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
I $
PROPERTY
Per accidentDAMAGE
$
NON -OWNED
HIRED AUTOS AUTOS
S
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE $
AGGREGATE $
EXCESS LIAR
CLAIMS -MADE
DED RETENTION$
S
WORKERS COMPENSATION
I WC STATU• OTH-
TORY LIMITS I ER
AND EMPLOYERS' LIABILITY Y I N
E.L. EACH ACCIDENT $
ANY PROPRIETORIPARTNERIEXECLITIVE
OFFICER/MEMBER EXCLUDED? ❑
N ! A
E.L. DISEASE - EA EMPLOYE $
(Mandatory in NH)
It yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT I S
DESCRIPTION OF OPERATIONS f LOCATIONS! VEHICLES (Attach ACORO 101. Additional Remarks Schedule, If more space Is required)
5125 Aviation Way #802
II1111llllllllllilllllllllll111111111111111111111111
C TY OF CALDWELL
4> 14 E LINDEN ST
CALDWELL ID 836o5
Ley _vLft311EF_I
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
ACORD 25 (2010105) 01988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD