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HomeMy WebLinkAboutPathway Concrete and LandscapeACC)REF ® DATE(MM/DD/YYYY) CERTIFICATE 4F LIABILITY INSURANCE 09I30/2024 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), 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 ofsuch endorsement(s)- PRODUCER CONTACT NAME: Kelsey Holder Kelsey C Holder Insurance Agency (75027K) PHONE FAX Farmers Insurance (A/C, NO, EXT): 208-955-6369 (A/C, No): PO Box 629 EMAIL Kuna ID 83634-4629 ADDRESS: kholder@farmersagent.00rn -_ INSURER(S) AFFORDING COVERAGE NAIC ✓f INSURED INSURERA: OHIO SECURITY INSURANCE COMPANY 24082 ' INSURERB: TRUCK INSURANCE EXCHANGE 21709 Pathway Concrete & Landscape Company LLC - — David A. Punzel INSURERC: IDAHO STATE INSURANCE FUND 19992 12495 Cinnabar Way INSURER D: Murphy ID 83650 INSURERE= INSURER F: COVERAGES CERTIFICATE NUMBER: - J REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME 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. INR TYPE OF INSURANCE �PDUT UI BPOLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE S 1.000,00 v CLAIMS MADE /� OCCUR DAMAGE TO RENTED $ PREMISES (Ea Occurrence) 100,000 �X MED EXP (Anyone person) $ 5,001 A rontractors Extension Y Y BKS (25)(fi 596�598- BY 08/15/2024 08/15/2025 PERSONAL &ADV INJURY $ 1,000,00 ivr t.v- ED GEN'L AGGREGATE LIMIT APPLIES PER: CALDWE CITY �I -- GENERAL AGGREGATE $ 2,000,000I POLICY ® PROJECT © LOC PRODUCTS -COMA/OPAGG $ 2.000,00 1 II OTHER: OCT 3-7fj" Borrowed Equipment $ $100,00 L+ AUTOMOBILE LIABILITY COM81N ED SINGLE LIMIT 1,000,00 $ (Ea accident) ANYAUTO BODILY INJURY (Per person) $ B OWNEDAUTOS SCHEDULED X ONLY X AUTOS BODILY INJURY (Per accident) $ Y Y 607048369 08/12/2024 081i212025 HIREDAUTOS NON -OWNED _ PROPERTY DAMAGE ONLY AUTOS ON LY $ (Per accident) UMBRELLA LIAO OCCUR EACHOCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED I RETENTION $ $ WORKERS COMPENSATION PER AND EMPLOYERS' LIABILITY OTHER $ STATUTE ANY PROPRIETOR/PARTNER/ Y!N E.L. EACH ACCIDENT $ 100,00 EXECUTIVE OFFICER/MEMBER N/A C Y N 1672430 04/01/2024 04/01/2025 E.L. DISEASE EAEMPLOYEE EXCLUDED? (Mandatory In NH) 100,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE • POLICY LIMIT $ 500,00 B Contractors Tools & Equipment N N 1607048357 08/10/2024 08/10/2025 Schedule $ 108,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required) Location(s): Those locations specifically defined within written contract Services: Poured Concrete Foundation and Structure Contractors Endorsements: As provided for on this FORM; Additional Insured, Primary Non -Contributory, Including Waiver or Subrogation Against Others by Written Contract or Written Agreement (CG 88 100413). CERTIFICATE HOLDER CANCELLATION I ityU C afdwelf F SHOULDANYOF HE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION c/o Cary Clerk DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 1179 AUTHORIZED REPRESENTATIVE . .-- ACORD 25 (2016/03) 1988-2015 ACORD CORPORATION. All Rights Reserved 31-1769 11 14 The ACORD name and logo are registered marks of ACORD