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`� CERTIFICATE OF LIABILITY INSURANCE 03/14/2024
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(ies) 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 Ileu of such endorsements .
PRODUCER RAC Jason Gardner _
Westem Community Insurance Co n D [] 7n�1, UM 4 F 208-401-0132 N¢ , 208-401-0137
APR J 1J
PO Box 4848 .
Pocatello
INSURED
Daniel Rule
5103 Aviation Way
ID 83205
INSURER A: Western Community Insurance
INSURER B
INSURER C
INSURER D :
INSURER E :
Caldwell ID 83605 1INSURER F
CAVFRAnFS CFRTIFICeTF NIIMRFR- REVISION NIIMRFR-
39519
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 LTRTYPE
OF INSURANCE
ADDL
UDR
POLICYNUMBER
POLICY EFF
POLICY EXP
uM�
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ❑X OCCUR
N
N
8M166203
04/13/2024
04/13/2025
EACHOCCURRENCE
$ 1,000,000
DAMAGE TO RENTE
PREMISES LEA occurrence
S 100,000
MED Face one n)
$ 10,000
PERSONAL& ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY JECT LOC
OTHER:
GENERAL AGGREGATE
$ 2,000,000
-COMPIOPAGG
s INCLUDED
-PRODUCTS
S
A
AUTOMONLELIABILRY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
COMBINED SINGLE LIMIT
Ea aoddent
S
BODILY INJURY (Per person)
S
BODILY INJURY (Per accident)
S
PROPERTY DAMAGE
Per scolden
S
s
A
UMBRELLALUIB
EXCESS LIAR
OCCUR
CLAIMS -MADE
EACHOCCURRENCE
S
AGGREGATE
$
DED I I RETENTION
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROMEMBEPIPARTUDED?EC��
OFF(Mandatory In NH)
if yes deealbe under
DESCRIPTION OF OPERATIONS below
NIA
PER OTH
STATUTE ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
S
E.L. DISEASE - POLICY LIMIT
S
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be allachad H more space In required)
Hanger: 5103 Aviation Way #654
CERTIFICATE HOLDER CANCELLATION
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?
m�
Caldwell ID 83605
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