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HomeMy WebLinkAboutEZ Rig CraneA� o CERTIFICATE OF LIABILITY INSURANCE DAT JMMM42fYYYY) 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 Ileu of such endorsement(s). PRODUCER CONTACT NAME: _ Cassondra Hendricks Rothstein Insurance Services, Inc. PHONE FAX 1591 Spinnaker Or IAICA9, E, 0: 805-648-6595 1 (AA NM: 805-435-1599 Ste 205 A_-MAII_E_Ss_. Csr rinsure.com Ventura CA 93001-5305 -DDRINSURERISP AFFORDING COVERAGE NAIC0 INSURER A: Mesa Underwriters Special Insurance Comp 36838 _ INSURED EZI`56 R-01 INSURER B : EZ Rig Crane Inc 1500 Palma Drive INSURER C : Unit A INSURER D : Ventura 93003 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMRFR-"9AR1no7 aFVlsinfu rulrivar o. 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. l�TR TYPE OF INSURANCE ADDLSUBR POLiCYNUMBER MW�OffYYYY POLICY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Y MP000400701917105 9/10/2024 91012025 EACH OCCURRENCE PREMISES (Ea oc'iE6 PREMISES Ea occurrence) $1,000000 $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY E J£CTT LOC GENERAL AGGREGATE $ 2,000 000 PRODUCTS - COMPIOP AGG $ 2,000 000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acadent $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYOAMAGE Per acadenl $ UMBRELLA LIAO OCCUR EACHOCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION$ $ WORKERS COMPENSATION PER AND EMPLOYERS' LIAaILITY Y r N ANYPROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDED? N/A ERI* E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) Or describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ -L DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attachad if more space Is rsquiredl The City of Caldwell is included as Additional Insured, per written contract. RECEIVED BY CALDWELL CITY CLERK MAR 2 7 2025 CERTIFICATE HOLDER CANCELLATION The City of Caldwell 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 rr"? / . ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD