HomeMy WebLinkAbout5K ServicesCERTIFICATE OF LIABILITY INSURANCE UAIrIM ULUTTTr'
4/16/2024
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), AUTHORIZE13
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION 18 WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not center rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER
Westem Community Ins Co
PO BOX 4848
Pocatello, ID832o5-4848
CT
PULLMAN LEANN
PHONE 208- 0 -6 6 FAl 208-232�608
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC2
INSURER A . Westem Communky Ins CO
39519
INSURED
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2INSUK SERVICES LLC
077 FA I RHAVEN
M1 bDLETON 1 D 83644
INSURER B :
RERC:
INSURER0:
INSURER E;
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: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 INSURANCEADDLSUBR
POLICY NUMBER
POLICY EFF
MMID
POLICY EXP
MMIDD
LIMITS
GENERAL LIABILITY
NCE
EACH OCCURRE-MMAGE
S 1,000,000
TO RE
PREMISES a oeearrenee
S 100,000
x COMMERCIAL GENERAL LIABILITY
CLA MS -MADE ❑X OCCUR
MED EXP Any one person)
S 10,000
PERSONAL a ADV INJURY
$ 1,000,000
A
Y
Y
8v9666o 1
5/01 /24
5/01 /25
GENERAL AGGREGATE
S 2,000,000
GEML AGGREGATE LIMIT APPLIES PER
PRODUCTS . COMPIOP AGG
s INCLUDED
POLICY1:1 PRO LOC
$
AUTOMOBILE LIABILITY
I L
a accident
$
BODILY INJURY (Per person)
$
ANY AUTO
AUTDOISMNED AUrOSSLED
NON -OWNED
HIRED AUTOS AUTOS
BODILY INJURY (Per ecciderd)
S
PROPS AGE
er accident
S
S
UMBRELLA LIAR
HCLAIMS-MADG
OCCUR
EACH OCCURRENCE
S
AGGREGATE
S
EXCESS LIAR
OED I I RETENTIONS
$
WORIMS COMPENSATION
AND EMPLOYERS LIABILITY Y I N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
(Mandatory in INN)
H dascrira under
SIPTiON OF OPERATIONS below
N I A
wo STATU OTH-
TORY LIMITS ER
E L EACH ACCIDENT
i
E L DISEASE - EA EMPLOYEd
S
E.L. DISEASE -POLICY LIMIT 1
$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, 9 more space is required)
Refer to I DCG 236 (03/07) Exclusion of Coverage for Structures Built Outside ;of-� py
Designated Areas Endorsement - Copy attached. GAf.F&tLi,.
APR I !1 2024
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CITY OF CALDWE LL
SS�99
CDEL[3TT
05ALWL10 8
ACORD 28 (2010105)
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 REPREaENTATIVE
04
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