HomeMy WebLinkAboutPacific Backflow LLCACORUF
%.-- CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIODIYYYY)
1 :01: S0^4
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 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).
PRODUCER
CORM
NAME: JO COIOm1)O
Fuhriman Insurancc
PHONE FAA
(A/C, No EMI : (208) 327-3400 (NC, No):
9603 W. Chinden B.vd
ADDRESS; jo@r fuhrimanins.com
INSURER(S) AFFORDING COVERAGE
NAIC S
Garden City ID R3714
INSURER A: OWNPRS INS CO
12700
INSURED
INSURERB: AUTO OWNE,RS INS CO
18988
iraegiicBaekliow I-I.0
INSURER C ;
3313 W Cherry L.n 11mb 726
INSURER D :
INSURER E :
Mcrrdian ID 83642-1119
INSURERF:
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.
LTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
MMIDDIYYYY)
(MMIDD/YY
LIMITS
A
x
COMMERCIAL GENERAL LIABILITY
CLAIMS -MARE FRI OGCUR
Y
57401492
06:29:20?4
r 06.V.JTJ
EACH OCCURRENCE
$ 1,000,000
PREMISES (Ea occurrence)
$ 300,000
MED EXP (Any one person)
S 10,000
PERSONAL & ADV INJURY
$ 1,000,000
'LAGGREGATE LIMIT APPLIES PER:
POLICY 7JECT F-1LOC
FOTHER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
B
AUTOMOBILE
LIABILITY
ANY AUTO
SCHEDULED
OWNEDOS ONLY AUTOS
AUT
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
5040149200
06, 29 2024
nyri
. 1 M
(Ea accident)
$ 1,OOD,OOO
K
BODILY INJURY {Per person)
$
BODILY INJURY (Per accident)
$
is
(Per accident)
S
UMBRELLA LIAR
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
Y PROPRIETORIPARTNERIEXECUTIVE
FFICERIMEMBER EXCLUDED?
Mandatory In NH)
I 0, describe under
CRIPTION OF OPERATIONS below
NIA
STATUTE ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Addillonal Remarks Schedule, maybe attached If more space Is required) �� '
CALDWELL CITY CLERK
City of Caldwell is included as Additional Insured
NOV 15 2024
CERTIFICATE HOLDER relUrFI I ATinN
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.
PO Box 1 179
AUTHORIZED REPRESENTATIVE
Caldwell, ID 83606
�
O 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of AZORD