HomeMy WebLinkAboutPatrick DriscollA� ® DATE {MMIDO YYM
CERTIFICATE OF LIABILITY INSURANCE 06/23/2023
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 endorsements .
PRODUCER CONTACT NAME, Jason Gardner- 771
Jason Gardner PHOMF 208-401-0132 FAX ANo .
525 S Middleton Rd. EMAIL
Middleton, ID 83644 1 ISURERIS1 AFFORDING COVERAGE NAIC 0
Farm Bureau Mutual Insurance COMDanv of Idaho 1 13765
INSURED INSURER B p
Patrick Driscoll INSURERC:
Jeanie Driscoll INSURERD:
1122 E Pine St. INSURER E:
Caldwell ID 83605 INSURERF:
COVERAGES CFRTIFICOTF NI IURFR' REVISION N"LgRFR-
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.
M6R
TYPE OF INSURANCE
POLICY NUMBER
M9 YEFF
rWgurnrm CYEXP
LIMITS
COMMERCIAL 0ENERALLIABILITY
EACHOCCURRENCE
S 500,000
CLAIMS -MADE FXI OCCUR
PREMISES Meoocurtenca
$
IJIED EXP (Any one non
$ 10,000
Farm Liability
A
X
Personal Liability
01-140586-01
07/11/2024
07/11i2025
PERSONAL& ADV INJURY
S
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
S
POLICY UEI�CT LOC
_
$
PRODUCTS-COMPIOPAGG
$
OTHER:
AUTOMOHILELWBILnY
COMBINED SINGLE LIMIT
Ea aeddent
$
BODILY INJURY (Per pemon)
S
ANY AUTO
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (PeractJtlerri)
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTYDAMAGE
Per accident
$
S
UMBRELLALUU°J
OCCUR
EACHOCCURRENCE
S
AGGREGATE
$
A
EXCESS LIAS
CLAIMS -MADE
DED I RETENTION
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
OFFICERIMEMB REX UD DTkNYPROPRIE'rORtPARTNERfEXECUTIVE ❑
NIA
I ER 0 '
STATUTE ER
E.L. EACHACCIpENT
$
E.L. DISEASE -EA EMPLOYEE
S
{Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
S
RICEIn/cn BY
(ALOINELL i., ly C,f
OESCRWnOV OF OPERATIONS I LOCATIONS / VEHICLES (ACORO 101. Additional Remarks Schedule, maybe aUached If more apace Is required)
4321 Aviation Way #107 Caldwell, ID 83605 WG 1
e'FDTIFICATF 1-In1 nFR CANICFI 1 ATlnm
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Caldwell
ACCORDANCE WITH THE POLICY PROVISIONS.
4814 E Linden St
AUTHOAI2EDREPRESEkTATNE
Caldwell, ID 83605
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