HomeMy WebLinkAboutH & H XRay ServicesAC- Ro oP CERTIFICATE OF LIABILITY INSURANCE
DATE (MMODlYYYY)
Rr270119A
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TH
,
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE PKiCii :R'
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: H the certificate holder Is an ADDITIONAL INSURED, the policy(Ees) 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
Ross Er Yerger Insurance, Inc.
100 Vision Drive, Suite 100
NAME: Allison Quick, CISR, ERIS
PHONE FAx
�NO W: 601-944-0982 Arc No :601-355-3227
Jackson MS 39211
ADDRESS:a uick rossand a er.00m
WSURER S AFFORDING COVERAGE
NAIC f
INSURER A: Indian Harbor Ins Co
36940
INSURED HSHX-RA-CL
H & H X-Ray Services, Inc.
P.O. Box 517
INSURERS: Zurich Amer Ins CO
16535
INSURERC: Scottsdale Ins Co
41297
INSURER D : Travelers Ind Co Of Amer
25666
West Monroe LA 71294-0517
INSURER E :
INSURER F .
1.vV1W-"M"&7 {acR11r1LAIG numoen;-1404rtSJ74:1 ncvlalU1V numbtn:
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.
INSR — — — SUBR POLICY POLICY EXP
TYPE OF INSURANCE _ - 'NoNp,WWp POLICY NUMBER mod.- ! LIMITS
A X COMMERCIAL GENERALLIABILITY~ Y US00142006LI24A I� 7/1/2024 7/1/2025 EACH OCCURRENCE $1,000,000
CLAIMS -MADE OCCUR °RE $ES a o6wrwraei $ 50.000
X 5,000 MED ExfjAqone $500 ,0
GEN'L AGGREGATE LIMIT APPLIES PER;
Z
El
POLICY JEI CT
LOC
OTHER.
B AUTOMOBILELIABILIIY
X ANY AUTO
OWNED
SCHEDULED
AUTOS ONLY
X HIRED X
AUTOS ONLY
AUTOS
NON -OWNED
AUTOS ONLY
O ! UMBRELLALIAS I X OCCUR
X EXCESS LIAR CLAIMS -MADE
DED LL RETENTION. m , ,
B WORKERS COMPENSATION
AND EMPLOYERS LIABILITY Y / N
ANYP ROPRIETORIPARTN ERlEXECUTI VE
OFFICERIMEMBEREXCLUDED? Fiij N/A
(Mendatwy In NH)
If ves. describe under
BAP353796902 1 711/2024 I 7112025
PERSONAL 8 ADV INJURY
$1,000.000
$2,000,0DO _
GENERAL AGGREGATE
PRODUCTS' COMPIOP AGO
$ 2,ODOr000
COMBINED SIN LE LIMIT
$1,0D0,000
,'FK WAider-)
_
$
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
$
PPROPERTY DAMAGE
$
99990
.-I
EACHOCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
!'tri
X OTH
E.L EACH ACCIDENT
E.L. DISEASE - EA EMPLOYS
E L DISEASE - POLICYLIMIT
D Leased/Rented EquOrner t QT6603226RO73TIA24 6I9/2024 7112025 PER ITEM LIMIT
A Contractors ul I US00142006LI24A 711Q024 7112025 PER OCCURRENCE
ProfelsknelI r
DESCRIPTION OF OPERATIONS r LOCATIONS r VEHICLES (ACORD 101, AddtkmW Rwnwks Schedule. may be attadmd a more tpeoe to required)
U800142007LI24A
711/2024 r
7112025
XNS00012735
711/2024
7/12025
7/1/2024
7112025
WC353796802
$1,000,000
$ 9,000,000
11.000,000
350,ODO
1,000,000
1,000,00D
CONTRACTOR'S POLLUTION LIABILITY: Policy #US00142006LI24A; Indian Harbor Ins Co; 7/1/2024-7/1/2025 Limits $1,000,000 Each Occurrence
/$2,000,000 Aggregate; Deductible: $5.000 Per Occurrence
PROFESSIONAL LIABILITY: Policy #US00142006LI24A; Indian Harbor Ins Co; 7/112024-7/112025 Limits $1,000.000 Each Claim42,000,000 Annual
Aggregate; Deductible: $5,000 Each Claim; Retro Date: 06/09/2006
GENERAL LIABILITY Policy #US00142006LI24A; Indian Harbor Ins Co; 711/2024-7/1/2025 includes Blanket Additional Insured, per written Contract (CG2010 &
See Attached...
OAI 4VI+t i l i; � � °7
n!Y MYRN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
496 + THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Caldwell Jul- 1 } 7021 ACCORDANCE WrTH THE POLICY PROVISIONS.
Attn: Gary Shoemaker
PO BOX 1177 AUTHORIZEDREPRESENTATIVE
Use
Caldwell, ID 83606-1177
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