HomeMy WebLinkAboutChris HoltonAC40 E)
�.� CERTIFICATE OF LIABILITY INSURANCE DA08120/20244
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(les) 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:
Jody Leonard-McCullough(7533C7K) PHONE FAX
2490 W Karcher Rd (A/C, NO, EXT): 208-918-2388 (A/C, No): 208-501-0729
E-MAIL
Nampa ID 83651-1539 ADDRESS: jleonard@farmersagent.com
INSURER(S) AFFORDING COVERAGE NAIC it
INSURED INSURERA: Truck Insurance Exchange 21709
HOLTiNSURER6: Farmers Insurance Exchange 21652
14051 S , NANDCHRIS INSURERC: Mid Century Insurance Company 21687
14051 SHENANDOAH CT INSURERD: Technology Assigned Risk 42376
CALDWELL ID 83607 INSURERE;
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY
REQUIREMENT. TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE
POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALLTHE TERMS, EXCLUSIONSAND COND-TIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADOTL SUER POLICY POLICYEXP
LTR TYPEOFINSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ 1,000.00
CLAIMS MADE OCCUR
DAMAGE TO RENTED
PREMISES(EaOccurrence)
$ 1
$
MED EXP (Any one person)
Y
PERSONAL& ADV INJURY
$ i,C
A
Y
507037208
05/16/2024
05/16/2025
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY ® PROJECT ❑ LOC
$ 2.0
GENERAL AGGREGATE
PRODUCTS•COMP/OPAGG
S 2.0
T
OTHER:
_
$
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Eaaccident)
$ 1.0
ANYAUTO
BODILY INJURY(Per person)
$
A
OWN50AUTOS SCHEOULEv
ONLY NAUTOS
N
1611112024
05/16/2025
BODILY INJURY(Faeracadent)
$
HIREDAUTOS NON -OWNED
ONLY AUTOS ON,Y
�07037306
PROPERTY DAMAGE
(Peraccident)
$
UMBRELt.ALIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAiMS.MADE AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION PER
AND EMPLOYERS'LIABILITY STATUTE C[OTH$
ANY PROPRIETOR.: PARTNER Y/N E.L. EACH ACCIDENT $ 100,
EXECUTIVE OFFICERrMEMBER — NIA ARID1030084-04 10/08/2023 10/08/2024
D EXCLUDED? (Mandatory in NH) I E.L. DISEASE - EA EMPLOYEE 100,
E.LDISEASE, POLICYLIMiT Is 500,
RECE)V f BY
GALp1VEL L i'iiY GI. FF;Fti
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101. Additional Remarks Schedule, may beattached if more space is required)
14051 SHENANDOAH CT, CALDWELL, 10 83607 a E P 2024
CERTIFICATE HOLDER
CITY OF CALDWELL
PO BOX 1179
CALDWELL
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THERc^c birrrirc um I oc DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
tI , V.0w by 09Fa.
AUTHORI21 # �� a - , �lI.coi !z
ID 83606 1 ?Ai
ACORD 25 (2016/03)
31 1769 11-15
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