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Home My WebLink AboutHaz-Tech DrillingHAZ-DRI-01 LVISGER ACORU' CERTIFICATE OF LIABILITY INSURANCE FDATE (MMIDDNYYYI 101212024 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(iss) 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 License # 26480 C ACT HUB International Mountain States Limited 167 River Vista Place PO Box 5099 HPONE (A�. No, Ext): (208) 734-1711 (Arc, NoI:(866) 912-75t34 A- I Twin Falls, ID 83303-5099 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: C010ny Insurance Company 39993 INSURED INSURERS: Cincinnati Insurance Company 10677 INSURERC:Alaska National Insurance Company 38733 Haz-Tech Drilling, Inc INSURER D : 1798 E Plaza Loop Nampa, ID 83687 INSURER E INSURER F : COVERAGES CERTIFICATE NUMRFR- REVISION NUMRFR- 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 INSURANCEADDL SUER POLICYNUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F7X OCCUR X X PACE4286683 101512024 71112025 EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED $ 100,000 MED EXP (Any one erson S 10,000 PERSONAL B ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY Zjra LOC OTHER: GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMPNOP AGO S 2,000,000 POLLUTION S 1,000,000 B AUTOMOBILE LIABILITY X ANY AUTO A4U�T�OpS ONLY ASVMED UTryOSSyU�¢L.�EDp AUTOS ONLY A�TOS ONE Y X X EBA0211391 101512024 71112025 i COMBINED SINGLE LIMIT acadenti S 1,000,000 BODILY INJURY Perperson)S BODILY INJURY Per accddenl S Oa, 7 AMAGE Per S S A UMBRELLA UAB EXCESS UAB X OCCUR CLAIMS -MADE EXC4286684 10/5/2024 7/1/2026 EACH OCCURRENCE s 4,000,000 X AGGREGATE s DED RETENTIONS Aggregate S 4,000,000 COMPENSATION AND EMPLOYERS' LIABILITYER ANY PROPRIETORIPARTNER/EXECUTIVE Y f N QpFnICEry EXCLUDED? 'y9N aI I e It yes, descnbe under DESCRIPTION OF OPERATIONS below NIA X 24DWS10095 41112024 4/1/2025 X PER OTH- STATUTEWORKERS E.L. EACH ACCIDENT 7 ,000,000 $ E.L. DISEASE -EA EMPLOYEE S 1,000,000 E.L. DISEASE - POLICY LIMIT S 1,000,D00 A A Pollution Site Pollution PACE4286683 PACE4286683 101512024 101612024 71112026 71112025 Per Occurrence Per Occurrence 1,000,000 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, miry be attached Ifmore space Is regulmtl For General Liability, the following forms) apply: EPACE100 07121, EPACE1 0107121, EPACE113 07114, EPACE107 64 For Auto Liability, the following form(s) apply: AA4171 11105, AA4172 09109, AA4174 11105 For Workers Compensation, the following forms) apply: WCDO0313 04184 MAR � A till D U fl C 2n25 30 Day Notice of Cancellation and 10 day Notice of Cancellation due to Non-payment in favor of holder. ,1 U RE: All Operations City of Caldwell Attn: Engineering Dept.1 ROW Permits P.O. 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 ACORD 25 (2016103) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD