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CERTIFICATE OF LIABILITY INSURANCE DarE(MMraomYY)
. kt 12/30/2024
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(,es) must 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 GARDNER JASON B CAT
Western Community Ins Co PHONE 2 208-401-01 FAX 208-232-3608
PO Box 4848 (AIc. NIt Eat,: 3 (urc, Ho)_
E-MAIL
ADDRE_S_S_: _
Pocatello. I D 83205-4848 INSURERS) AFFORDING COVERAGE _ NAIC A
INSURED
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ENVISION CONSTRUCTION LLC
19448 BLACKBERRY LN
CALDWELL ID 83607
INSURER A, Western Community Ins Co 39519
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INSURER B : I
INSURER C : I
INSURER D : .
INSURER E:
COVERAGES CERTIFICATE NUMRFR- 17FV1SIr]IU IJIIMRFR•AF0670
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 TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP
LTRPOLICY NUMBER MMIDDIYYYY MMlDDIYYYY LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
PREMISES Ea occurrence
$ 100.000
)( COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE DIOCCUR
MED EXP (Any one person)
$ 10,000
A
Y
N
BV486301 1 / 13/25 1 / 13/2G
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2 000 000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS • COMPIOP AGG
$ 2 O00 000
)( POLICY PRO- LOC
JECT
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY Per accident
( )
$
NON -OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAGE
Per accident
$
$
UMBRELLA LIAR
HCLAIMS-MADE
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LMS
DED I I RETENTIONS
$
WORKERS COMPENSATION
I WC STATIU OTH-
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETORIPARTNERIEXECUTIVE ❑
OFFICERIMEMBER EXCLUDED?
N 1 A
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
(Mandatory in NH)
li yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
1 $
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required) p� WL�fC N CLERK
Refer to I DCG 236 (03/07) Exclusion of Coverage for Structures Built �u" t� I dee
Designated Areas Endorsement - Copy attached.
JAPJ 0 6 2025
CERTIFICATE HOLDFR CAIJCCI I ATlnlu
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
n nt n
I I I I I
CITY OF
f
I 11 III I I I I I I I 111
n nn I t n I unr a unI
CALDWELL
ACCORDANCE WITH THE POLICY PROVISIONS.
A: THORIZED REPRESENTATIVE
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414 E LINEN ST
CALDWELL ID 83605
Z,I" /' �a
AGUKU LO tXulutuo) Oc 1958-ZU1U ACORD CORPORATION. All rights reserved.
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