HomeMy WebLinkAboutPROOF OF LIABILITY - 17-00792 - Shilo Automatic Sprinkler Fire Safety Certification®DATE (MM1DDNYYY)
CERTIFICATE OF LIABILITY INSURANCE
9/5/2017
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 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).
PRODUCERCONTA NAME: T Mar Thibodeau
Y
ISU Cunnington & Associates PHONE Ext) (208} 672-6180 iAX
'C No): (208)375-8280
E-MAIL mar @cunnin tonins . com
P.O. BOX 429 annlae=cc• Y g
Eagle ID 83616
INSURED
Shilo Automatic Sprinkler Inc.
1224 11th Ave N
Nampa ID 83687
rnvconr_cc f'=0TICit°ATr- KIIlRARF:P•9-30-17
INSURERA:NautilusInsurance Co. 17370
INSURERB:National Union Fire Ins. Co. 19445
INSURERC:Scottsdale Ins Co 41297
INSURERD:Ins. Co. State of Pennsylvania 01942
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
LTR
TYPE OF INSURANCE
ADDL
SUBR
POLICY NUMBER
POLICY EFF
MM0/YYYY
1D
POLICY EXP
MM/DD/YYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
A
CLAI}v1S MADE1XI OCCUR
DAMAGE TO RENTED 100,000
PREMISES (Ea occurrence)____$_
MED EXP (Any one person) $ 5,000
ECP200386716
9/30/2017
9/30/2018
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE $ 2,000,000
PRODUCTS - COMP/OP AGG $ 2,000,000--
POLICY !-" PES [:] LOC
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $ (E 1,000,000
a accident}
BODILY INJURY (Per person) $
B
X ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
X HIRED AUTOSX AUTOS
CA 4489601
4/1/2017
4/1/2018
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
Per accident)
Medical payments $ 5,000
X UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE $ 5,000,000
AGGREGATE $ 5,000,000
C
EXCESS LIAR
CLAIMS -MADE
DED RETENTION$ 10,000
$
UMS20028198
9/30/2017
9/30/2018
WORKERS COMPENSATION
STATUTE X ORH-
D
AND EMPLOYERS' LIABILITY y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER H) EXCLUDED? a
(Mandatory in NH)
N / A
WC 12016222
4/1/2017
4/1/2018
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE - EA EMPLOYE $ 1,000,000
E.L. DISEASE - POLICY LIMIT $ 11000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
A
Professional Liability
ECP200386716
9/30/2017
9/30/2018
Per Occurrence 1,000,000
Retro date 9/30/2009
Deductible 5,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
Proof of Coverage
Gt.K 1 It- IUA It HULUChC a.r M1r-Ld.r+ I rill
(los)2s7-7129
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Ada County Department of Administration THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
200 W. Front Street ACCORDANCE WITH THE POLICY PROVISIONS.
Boise, ID 83702
AUTHORIZED REPRESENTATIVE
Mary Thibodeau/MARY
V I VOO-GU"1$ f %,UKU L VRr-Ur%M I RUM MIR I IVI Ica I WOo rcu.
ACORD 26 (2014/01) The ACORD name and logo are registered marks of ACORD
INS025 (201401)