HomeMy WebLinkAboutCERTIFICATE OF LIABILITY - 19-00016 - Phoenix Fire Protection -Annual Certification �. PHOF'001 OP ID. SP
J ' DATE(MMIDDFYYYY)
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CERTIFICATE OF LIABILITY INSURANCE 1 0110812019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON! THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOVES 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 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.
PRODUCER CONTACT
WP Insurance NAME
904 12th Ave S wuc n o.:F t,.208-466-21662 C No): 208-466-1840
Nampa,ID 83651 E'MAIL ADDRESS:
Scott D,P°Pool ...
INSURES)AFFORDING COVERAGE _ NATO p'.
INSURER A:Id State Insurance Fund 36129
INSURED Phoenix
Management irotection,Services LLC nc Company .mm.�_.
INSURERC:Auto Owners Insura . �2__. 189888
, INSURER B:Adr'Itiral Insurance nce Co 18988
Trent&Rebecca Bice
4130.Airport Rd. Co.. 256 23
INSUR.E.R.D:Travelers Insurance
p Insurance Co. 14484
Nampa, ID 8i3fYgf INSURER E:HuLtlsQr'I FXC�eSS InSu �..,,.. ...
INSURER r:
COVERAGES CERTIFICATE NUMBER: 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.
INSR e,-m. ......�................... Atffill ab` ._ .� _.. POLIG'f EBF-POLICY EXP .__...,............ ... .e-,�.....-.._..
LTR TYPE OF INSURANCE INqR WVD POLICY NUMBER 1MMIDDfYYYYI LIMITS
GENERAL.LIABILITY EACH OCCURRENCE $ 1,000,00
B X COMMERCIAL GENERAL LIABILITY X X CA000022189-03 0810612018 0810612.019 SCF TO REMISES Eaa occurrence) 166 00
P ..rrr�nce $ ,
..... CLAIMS-MADE p X I OCCUR MED EXP(Any one person) $.,,..... 5.00
........ .....-----..
PERSONAL&ADV INJURY' $. 1.,000.,06
GENERALAGGREGRT ....,. "-'.'�__..
F s 2,666,06
GEN'l,AGGREGATE LIMIT APPLIES PER PRODUCT'S COMPPµ�. .__
LOP Acts $. 2,006,00
POLICY. X PRO- LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1.,00'0,00
Ea -rdent,). . . .._e. _.. '$
C X ANY AUTO 5044285900 0810712018 08/0712019 BODILY INJURY(Per person)
ALL OWNED
SCHEDULED I BODILY INJURY IPeraccident) $
AUTOS AUTO'S � �. ...............W..-....
X HIRED AUTOS ( NN-OWNED PROPERTY DAMAGE
AUOTOSPER ACCIDENTI _ – –
i
$
UMBRELLA LIAR X OCCUR 'EACH OCCURRENCE $ 1,000,00
E X EXCESS T_IAB CLAIMS-MADE HXS10006'30 01 081061AGGREGATE
2018 0810612019 A
$
DED I I.RETENTION$ $
WORKERS COMPENSATION X WC STATU- I Xr OTH-
AND EMPLOYERS'LIABILITY TUR . R
A ANY PROPRIETORIPARTNEIR'IEXEOUTIVE YIN 610558 0710112018 0710112019 E.L EACHACCIDENT $ 1,000 00
OFFICERIMEMBER EXCLUDED? F7 N P'A
(Mandatory In NHI _
E.L DISEASE EA EMPLOYEE, $� 1,000,000
If ns,describe under .E..L..DISEASE-POLICY DESCRIP'nON OF OPERATIONS below Y LIMIT $ 1,.000,00
D Property of Others 660-8451L584 0810712.018 0810712019 Stored 50,00
Materials
DESCRIPTION OF OPERATIONS!LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space Is requlred)
CERTIFICATE HOLDER CANCELLATION
CITYORI
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Rexburg ACCORDANCE WITH THE POLICY PROVISIONS.
35 N 1 st E
Rexburg, ID 83440 AUTHORIZED REPRESENTATIVE
Scot#.
Q 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and I a are registered marks of ACORD