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ACORO CERTIFICATE OF LIABILITY INSURANCE
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(ies) 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 endorsements .
PRODUCER
CO TACT
Three Rivers Insurance, Inc.
910 E Cleveland Blvd
Caldwell, ID 83605
PHONE FAX
ArC, No, Et): (208) 454-1424 ArC, Ne :(208) 459-4730
E I
INSURE S AFFORDING COVERAGE
NAIC p
INSURERA:Auto-Owners Insurance Company
18988
INSURED
INSURER 8: Idaho State Insurance Fund
36129
INSURER C :
IDAHO SPECIALTY COATINGS
INSURER D :
613 Cottonwood St
Caldwell, ID 83605
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER- RFVISIAN NIIMRFR-
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
ADOL
SUBR
POLICY NUMBER
POLICY EFF
POLICY EXPLTR
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$
DAMAGE TO RENTED
CLAIMS -MADE OCCUR
MED EXP (Any oneperson)
$
PERSONAL 8 ADV INJURY
$
GEML
GENERAL AGGREGATE
AGGREGATE LIMIT APPLIES PER:
POLICY El jpa LOC
PRODUCTS -COMPIOPAGG
OTHER
A
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea accident)ANY
$ 1'050,000
tx , LY INJURY Perperson)
AUTO
4976003401
4/2512024
4125/2025
OWNED SCHEDULED
AUTOS ONLY AUUpTOppSyyyyry�yEEpp
Ix
8k0DILY INJURY Per accident
PPerOacaAent AMAGE
100,000
AUT650NLY AUTO50NLY
Ix
UMBRELLA LIAB OCCUR
HCLAIMS-MADE
EACH OCCURRENCE
$
AGGREGATE
EXCESS LIAR
DIED I I RETENTION$
S.
B
WORKERS COMPENSATION
X PPER E OTH-
AND EMPLOYERS' LIABILITY
AAQNN�YPROPRIIETgOERRIPARTNERIEXECUTIVE YIN
(Mandatory In NH) XCLUDED7 Y
N yes, describe under
DESCRIPTION OF OPERATIONS below
N 1 A
663069
8723I2D24
812312025
E.L. EACH ACCIDENT
1,000,000
$
E.L. DISEASE - EA EMPLOYE
1 'Da00aa
E L DISEASE - POLICY LIMIT
1 oaa 0oa
' '
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may he attached If more space Is required)
Insurance Requirements
The awarded firm will provide the insurance coverage designated hereinafter and in future Contract Provisions and pay all costs associated with the
insurance coverage. Any submitted Insurance policy or Certificate of Insurance will identify the City of Caldwell (Attn: Purchasing, P.O. Box 1179, Caldwell, ID
83606) as the Certificate Holder and the Additional Insured, and such insurance policy or Certificate of Insurance will always be kept and maintained in full
force and effect during the term described In future Contract Provisions. The insurance policy or Certificate of Insurance must be filed with Purchasing before
commencing work under this contract, and no insurer will cancel the policy or policies or Certificate of Insurance without first giving thirty (30) days' written
notice to the awarded firm and the City of Caldwell. The awarded firm may, at any time, substitute a policy or policies or Certificate of Insurance of a qualified
SEE ATTACHED ACORD 101
CAQ
City of Caldwell
Purchasing, t
PO Box 1179
Caldwell, ID 83606
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
4\a.-
ACORD 25 (2016103) 1988-2016 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD