HomeMy WebLinkAboutExtreme Concrete ConstructionCERTIFICATE OF LIABILITY INSURANCE
DATE (MMfDDA7M
5/29/2025
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 endorsement(s).
PRODUCER
Arthur J. Gallagher Risk Management Services, LLC
PO Box 429
Eagle ID 83616
INSURED
Extreme Concrete Construction, Inc
12740 La Mirada Lane
Melba ID 83641
Liliana Cruz Leon
rtr 801-924-1400
FAX
{AIC, Noj:
INSURER A: Auto -Owners Insurance Company 18988 l
f INSURERS: Idaho Slate Insurance Fund 36129 1
COVERAGES CERTIFICATE NUMBER:357810084 REVISION NUMBER:
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.
{LTA
TYPE OF INSURANCE
ADDL
SUER
POLICY NUMBER
MWDDYNYYY
MMO POLICY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X OCCUR
y
57775623
702024
7/2/2025
EACH OCCURRENCE
$ 1.000.000
DAMAGE T�R�NT D
PREMISES Ea occurrence
$ 300,D00
MED EXP (Any one person)
S 10,000
PERSONAL S ADV INJURY
$ 1.000.000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY [fl jE4 M LOC
GENERAL AGGREGATE
$ 2.000.000
PRODUCTS -COMPIOPAGG
$ 2.000,000
$
OTHER
A
AUTOMOBILE
LIABILITY
5077562304
7/2/2024
7/2/2025
EO BINEDISINGLE LIMIT
$ 1,0OO,ODO
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
IX
Per accident)
BODILY INJURY ( )
$
HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
X
PROPERTY DAMAGE
Per accident)
S
S
A
X
UMBRELLALIAB
X
OCCUR
5077562301
702024
7/2/2025
EACH OCCURRENCE
S1,000,000
AGGREGATE
S 1,000,000
EXCESS L1AS
CLAIMS -MADE
DIED I X I RETENTION$
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y!N
636934
711l2024
7/1/2025
X STA TUTE I I ERH
E.L. EACH ACCIDENT
—
S 2,000,000
ANYPROPRIETOPJPARTNERfEXECUTIVE
OFFICERIMEMSER EXCLUDED?
N ! A
E.L. DISEASE - EA EMPLOYEE
S 2,000,000
(Mandatory In NH)
II yes, describe under
E.L. DISEASE - POLICY LIMIT
$ 2,000,000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS 1 LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space is requiredl E C E IV E D BY
RE: ROW1196
City of Caldwell is listed as additional Insured on the General Liability policy as required by written contract.CALDWELL CITY CLERK
MAY 3 0 2025
CERTIFICATE HOLDER CANCELLATION
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.
AUTHORIZER
9 IVUU-205 ACUKU CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD