HomeMy WebLinkAboutMichels Pacific Energy Inc.t eye L VL L
ACO CERTIFICATE OF LIABILITY INSURANCE DATEfMM+D)
ex/22/2024zoza
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 1NSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisfons 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 endorsements .
PRODUCER CONTACT willis Towers watson Certificate Center
Hillis Towers Itatson midwst, Inc. PHONE
c/o 26 Century Blvd 1-877-945-7378 ArC No: 1-888-467-2378
P.O Box 305191 RECEIVED BY APN ; Corti ficates@wilIts -cam
Nashville, TN 372305191 USA CALDWELL CITY CLERK INSURER(S) AFFORDING COVERAGE NAICs
INSURED
141chels Pacific Energy, Inc.
9433 Dovcor Lane
Tumwater, Wk 98512
}� INSURERA, Greenwich Insurance Company 22322
FEB_ V 2 r 024 INSURERS; XL Insurance America Inc 24554
INSURERC: )U' specialty Insurance Company 37885
INSURER D
COVERAGES CPATIFICATF NLIMBFR- W32520456 RF:VICIn1j MrII1J cica•
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 (S SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCEDBY PAID CLAIMS.
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ILTR TYPEOFINSURANCE AODL$lf(Ifl POLICY NUMBER MWDOrYYYY MMM)LO YRY LIMITS
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
Is 31000,000
DAMAGE TO RENTED PREMISF�S {Ea o _ r nce
S 1,000,000
CLAIMS MADE OCCUR
MED EXP (An one rson)
$
A
Y CGD740955307 02/01/2024
02/01/2025
PERSONAL R ADV INJURY
$ 3,000,000
GENERAL AGGREGATE
S 61000,000
G''EN'L AGGREGATE LIMIT APPLIES PER:
�ILOC
I POLICY LX JEST
PRODUCTS • COMPIOP AGO
S 6,000,000
$
OTHER:
AUTOMOBILE
LIABILITY
COMM El SINGLE LIMI $ 5,000,000
[Ea accidint __
X
ANY AUTO
BODILY INJURY (Per person) S
A
OWNED SCHEDULED Y CAD740955407 02/01/2024
AUTOS ONLY AUTOS
02/01/2025
BODILY INJURY (Per accident)
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
�Prtr.pyCi{Iena)
S
I$
B
X
UMBRELLA LIAB X I OCCUR
I EXCESS LIAO _CLAIMS MADE
U800077661LI24A 02/01/2024
02/01/20251
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
DED RETENTIONS
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y 1 N
C ANYPROPRIETORPARTNEREXECUTIVE
OFFICERMEMBEREXCLUDED? Na
(Mandatory In NH)
It yyeer s, describe und
0 as,OF OPERATIONS below
N'A C11D710955107 02/O1/2024
02/O1/2025
JXJPER
ERH
E L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
S 1,000,000
S L,000,000
E.L. DISEASE - POLICY LIMIT
$ 1, Soo, 000
C Workers Compensation - III CHR740955207 02/01/2024
02/01/2025 E.L. Each Accident
411000,000
and Employers Liability
E.L. Disease-Eaoh E
$1,000,000
Work Comp: Per Statute
B.L. Disease-Pol Lmt142,000,000
DESCRIPTION Of OPERATIONS: LOCATIONS 1 VEHICLES (ACORD 101, Additional Rwm*s Schedule, may be attached If more space is required)
City of Caldwell is an Additional Insured with respect to the General Liability and Auto Liability coverages and the
work performed by the Named Insured when required by written contract, agreement or permit executed prior to loss,
I'_FRTIFIrATF HCII nFR P'AMf`FI I ATIrkM
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City Of Caldwell
AUTHORIZED REPRESENTATIVE
412 Blaine Street
Caldwell, ID 83605
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01VUti-ZU15 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
an 111: 25315690 8ATcH: 3297849
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