HomeMy WebLinkAboutRalph Korn�.� CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
02/01/2024
THISCERTIFICATE IS ISSUEDASAMATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPONTHE 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: Ifthe certificate holder IsanADDITIONAL INSURED, the policy(in) must have ADDITIONAL INSURED provisions or be endorsed. IfSUBROGATION 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
CONTACT
NAME: Dustin Hiersekom
Kelsey C Holder
PHONE
FAX
Farmers Insurance
(A/c,NO, EXT): 208-955-6369
(A/C, NO); 208-955-6386
PO Box 629
Kuna ID 83634
E-MAIL
ADDRESS: dustin.kholder@farmersagency.com
INSURERS) AFFORDING COVERAGE
NAIC X
INSURED
INSURERA: Truck Insurance Exchange
21709
INSURERS: Farmers Insurance Exchange
21652
KORN, RALPH
INSURERC: Mid Century Insurance Company
21687
1104 N 9TH AVE
INSURER D:
CALDWELL ID 83605
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED, NOTW ITHSTAND ING ANY
REQUIREMENT, TERM OR CONDITION OF ANYCONTRACTOR OTHER DOCUMENT W ITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE
POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICI ES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPEOFINSURANCE
ADDTL
INSD
SUER
WVD
POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 2,000,00
CLAIMS-MADEOCCUR
I—XI
DAMAGE TO RENTED PREMISES (Ea Occurrence)
$ 100,00
MED EXP (Anyone person)
$ 5 00
PERSONAL &ADV INJURY
$ 2,000,00
C
06650148
02/12/2024
02/12/2025
GEN'L AGGREGATE LIMITAPPLIES PER:
GENERAL AGGREGATE
s 4,000,00(
POLICY ❑ PROJECT ❑ IOC
PRODUCTS - COMP/OP AGG
S 2.000.00
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY(Per Person)
$
ANY AUTO
OWNEDAUTOS SCHEDULED
ONLY AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Peraccident)
$
HIREDAUTOS NON -OWNED
ONLY AUTOSONLY
UMBRELLALIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESSLIAB
CLAIMS -MADE
DED I I RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
PER
STATUTE
OTHER
$
E.L. EACH ACCIDENT
$
ANY PROPRIETOR/PARTNER/ Y/N
EXECUTIVE OFFICER/MEMBER
EXCLUDED? (Mandatory in NH)
N/A
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICYLIMIT
$
If yes, describe under DESCRIPTION OF
OPERATIONS below
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
Locations): 512 Taildragger Place Caldwell, ID 83605
CERTIFICATE HOLDER CANCELLATION
City Of Caldwell
4814 E Linden St
Caldwell, ID 83605
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 REPRESENTAT:y5 �/
vv QX/
ACORD 25 (2016/03)
31-1769 11-15
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