HomeMy WebLinkAboutProduction Services International� 0 DATE (MNWDIYYYYI
A�� V CERTIFICATE OF LIABILITY INSURANCE 07/30/24
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(les) 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 endorsements .
TAGIDAROLD K DOUGLAS INS AGENCY
CONTAPRODUCER NAME: Jill Anderson
PHONE 303 782-5151 AjC,No1: (303)782-5511
1776 S Jackson St #1106
ADDRIESs: •ill dou Iasi nsurancegrou .corn
INSURERS AFFORDING COVERAGE
NAIC #
Denver, CO 80210
INSURER A: Auto -Owners
INSURED
INSURERB: Liberty Mutual
INSURERC: Pinnacol
Production Services International, Inc.
INSURER0:
PO Box 100382
INSURERE:
Denver, CO 80250
INSURER F :
rnVcverr=c (r-0TI9:Ir ATI= NIIMRF:R- 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.
ILTRR ADDLTYPE OF INSURANCE IF= SUBR POLICY NUMBER MMIDD1YYYY ICY EFF MMIDDI EXP LIMITS
X
COMMERCIAL GENERAL LIABILITY
OCCURRENCE S 1,000,000
_EACH
IMIWNTELF
S 300,000
X
CLAIMS -MADE OCCUR
Incld Contractual Liab. I
PREEMkSES a2 rrenrs
MEDEXP (Any oneperson) $ 10,000
A
Y I
Y
7-49630e4, 74252454 & 7425246
08101)24
08101125
PERSONAL & ADV INJURY S 1,000000
GEN'L
f
AGGREGATE LIMIT APPLIES PER:
ENERAL AGGREGATE S 2000,000
GD_MPIOPAGG
JECFX PRO- F
OUCTS-COPOLICY 2,0001000
_$
S
OTHER:
AUTOMOBILE LIABILITY
_ _
i OMd den SINGLE LIMIT
S 1,000,000
S
ANY AUTO
BODILY INJURY (Per person)
$
A
OWNED SCHEDULED
Y
Y
5396808401, 02, 03
08101/24
08101125 BODILY INJURY (Per accident)
AUTOS ONLYHAUTOS
HIRED NON -OWNED
1Hired
``
PROPERTY DAMAGE
�denl
S
AUTOS ONLY AUTOS ONLY
PD
k
$1001$250 deds.
S 200,000
X
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$ 5,000,000
S 5,000,000
A
EXCESS LIAB
M
CLAIMS -MADE
Y
Y
53-968084-00
08/04/24
08/01/25
AGGREGATE
DIED I X I RETENTIONS 10,000
form
S
WORKERS COMPENSATION
�f/ollows
STATUTE ERH
C
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIFXECUTIVE —
NIA
Y
4238496 & 7521602
08/01/24
08/01125
E,L. EACH ACCIDENT
$ 500,000
E.L._DISEASE _ EA EMPLOYE
S_ 5a0,p00
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
If yes, Oe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT
S 500 000
Rentedf nnothere
1,000,000
B
Inland MarinelEquipment
Y
Y
BMO 63994876 08101124
OO10112s
Rented to others
$1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
As required by written contract or written agreement, the City of Caldwell are included as Additional Insured
for ongoing and
completed operations under General Liability on a primary and non-contributory basis.
City of Caldwell
411 Blaine St
PO Box 1179
Caldwell, ID 83606
AUG 2024 I 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 Rr&PRESENTATIVE
5 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD