HomeMy WebLinkAboutShannon & Wilson Inc.ACC oY CERTIFICATE OF LIABILITY INSURANCE
DAT112 zo2'� "}
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(iss) 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
CONTACT
NAME: Regina Caindoy
Arthur J. Gallagher Risk Management Services, LLC
FAX
PHONEo•
10900 NE 8th St.
E,rq: 425-5$6-1034
w Af{_. C,No)! —
Ste 750
ADDRESS: re ina r—aind2y@pjg.com
INSURERS AFFORDING COVERAGE
NAIC 0
Bellevue WA 98004
INSURER A: National Union Fire Insurance Comfy of Pittsburg19445
INSURED
INSURER B : New Hampshire Insurance Company
23841
Shannon & Wilson. Inc.
5260 W Chinden Blvd
INSURERC:
INSURER D :
Boise, ID 83714
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER:53874928 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY P€'RIOD
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.
IN SR TYPE OF INSURANCE P6LICY EFF POLICY EXP
i POLICYNUMBER MMODIYYYY MMIDDlYYY
LIMITS
A
- X
; COMMERCIAL GENERAL LIABILITY
Y
5180256 311/2024 311/2025
EACH OCCURRENCE $ 1.000,000
X, OCCUR
DAMACLAIMS-MADE
. PREMISE{ occurrence) . $300.000
MED EXP (Anyone person) $10,000
PERSONALBAOV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE $2,000,000
_ I POLICY JECT FILOC
PRODUCTS - COMPIOP AGG S 2,000,000
OTHER:
$
A AUTOMOBILE LIABILITY
2961686
3/1/2024 3/1fF025
COMBINED SINGLE LOW $1.000,000
?EP Pwdenll
X ANY AUTO
BODILY INJURY (Per person) , $
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident); $
- HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE $
jar aoglenl) _
$
UMBRELLA LIAB OCCUR
EACHOCCURRENCE
$
$
EXCESS LIAB ' CLAIMS -MADE'
AGGREGATE
$
DED RETENTIONS
A WORKERS COMPENSATION WC012016021P(AOS)
B AND EMPLOYERS' LIABILITY YIN WC012016020(CA)
ANYPROPRIETORIPARTNERIEXECUTIVE
311/2024
31112024
311/2026
311/2025
'X I PERT T O�H-
—
E.L EACH ACCIDENT
"
S1.000000
OFFICERIMEMBEREXCLUDED? NIA
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE
S1,000000
!f qes, describe under
DESCRIPTION OF OPERATIONS below
E.L DISEASE -POLICY LIMIT
S11.000000
DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached If more space Is required)
Re Workers' Comp- in Monopolistics Employers' Liability only
City of Caldwell is included as Additional Insured for General Liability (per CG2010 and CG2037) as required by written contract upon execution of written
contract.
RE: Ward Lane over Mason Creek Bridge. S&W Job No. 114697. TT
I17:leJ rS aJ R:1
City of Caldwell JAN 2 2 2024
411 Blaine 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 REPRESENTATIVE
0 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD