HomeMy WebLinkAboutG & S ExcavationACC>R o® CERTIFICATE OF LIABILITY INSURANCE
DATE(MM11D20YYYY)
111153
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 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 endorsement(s).
PRODUCER
CONTACT Kathy Barnes
NAME.
Midtowne Insurance Agency
PHONE (208) 459-9422 F {208) 459-9417
IX
AIC No A!C No
6618 Cleveland Blvd.
AODRESS: kabames@acnsure corn
Suite A
INSURER(S) AFFORDING COVERAGE
NAIC N
Caldwell ID $360 7
INSURERA: The Ohlu Casualty Insurance Company
24074
INSURED
INSURERS: West American Insurance Company
44393
G & S Lxcavation LLC
INSURERC: IDAHO STATE INSURANCE FUND
9999
13937 Indiana Ave
INSURER D :
INSURER E .
Nampa ID 83651
INSURER F :
COVERAGES CERTIFICATE NUMBER: CL73111504106 REVISION NUMBER,.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED
TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REOUIREMEN-. 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 POL CIES
DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED
BY PAID CLAIMS
INSR -.— ---- -
LTR TYPE OF INSURANCE p POLICY NUMBER _
LI Y EFF LIMITS
MwowfYYY MMID
- -
$ 1,000,000
S 1.060.000
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE Fx-] OCCUR
EACH OCCURRENCE
PREM1 Eaoaarrence}
$ 15.000
MED EXP tAreir one persani
PERSONAL& ADV INJURY
A
N
N
SK057743047
04122/2024
04/2212025
$ 1,000.000
GfN'L AGGREGATE LIMIT APPLIES PER
X POLICY El PRO-
JECT LOC
GENERAL AGGREGATE
PRODUCTS • CpMP+[:PAGG
[Lessor
$ 2,000.000
S
OTHER:
Equip Specific
S
S 1.000.000
_
S
AUTOMOBILE LIABILITY
X ANY AUTD
COMBINED SINGLE LIMI'
Ea acadenlF m
BODILY INJURY (Per person)
B
OVNJEO SCHEDULED
AUTOS ONLY AUTOS
N
N
BAWS7743047
04/2212024
04122/2025
BODILY INJURY (Per accident)
$
HIRED NON OVINED
AUTOS ONLY _ AUTOS ONLY
----
S
PROPERTY DAMAGE
',Per aocldenn_
EACH OCCURRENCE
X
UMBRELLA LIAR
X OCCUR
$ 5000000
AGGREGATE
A
EXCESS LIAB
CLAIMS -MADE
US057743047
0412212024
04/22/2025
$ 5000D00
DED RETENTION S
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED? El
(Mandatory in NH)
11 yes, desciibe under
DESCRIPTION OF OPERATIONS below
NIA
N
561776
10/0112023
10/01/2024
X STATLFTE 10 RH
E.L.EACH ACCIDENT
S 1000000
E.L. DISEASE - EA EMPLOYEE
E,L- DISEASE - POLICY LIMIT
$ 1000DOO
-
S 1000000
x I I I tiI'1= -
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) E IY
Proof of Coverage. 2001 Komatsu CD60R Tracked Dump Truck equipment value $70,000
City of Caldwel%
A p R 12024
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
n 1988-2015 ACORD CORPORATION. All rights reserved.
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