HomeMy WebLinkAboutCERTIFICATE OF LIABILITY INSURANCE - 08-00108 - A-1 Fire Protection Services - Fire Safety Certificationx1117— 29. 2008_ 3:4/PM No
WORA, CERTIFICATE F LIABILITY INSURANC
8 U�(208) $22-7778 FAX (208)522-0404 THIS CERTIFICATE IS ISSUED AS A MAI
Bustle Lake Insurance ONLY AND CONFERS NO RIGHTS UPON
P.O. BOX 2751 HOLDER. THIS CERTIFICATE DOES NOI
ALTER TH COVE 0 FF RD BY
Idaho Falls, ID 83403
Bruce Waldram INSURERS AFFORDING COVERAGE
ISURED Fire Protection Services, LLC INSURERA Arch Insurance Comoanv
PO BOX 2961 INSURER B:
Idaho Falls, ID 83403 INSURER C:
INSURERD:
NSURER E:
C(1VFRAr FA
0141—P. 1/2-
1 uATE(MmIuw""
NAIL #
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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY RE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
AD9
INA09
TYPEOFINSURANCE
POLICY NUMBER
POUCYEPPECTW
02/27/2008
POUCYFXPIRATION,TO
UMR8
GENERAL LIABILITY
MFGL07199600
02/27/2009
EACH OCCURRENCE $ 1 QOp 00
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED $ 100,0
CIAIMS MADE a OCCUR
MED W (Any ore pe ) ; 5,000
A
PERSONAL& ADV INJURY 6 1,000,000
GENERAL AGGREGATE $ 2.000 ,000
GENL AGGREGATE LIMIT"PLIES PER
PRODUCTS. COMPIOP AGO S 21000.00
X POLICY 7 jEc7 F7 LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(EA afrideM) $
BODILY INJURY IS
(Pw POO)
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
IF&xc ) $
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE $
(Per avldem)
OARAOEUABILnY
AUTO ONLY -EA ACCIDENT $
OTHER THAN EAACC $
ANY AUTO
AUTO ONLY: AGG $
EXCESSNMBRELLALIABILTTY
EACH OCCURRENCE $
OCCUR F7 CLAIMS MADE
AGGREGATE S
6
6
DEDUCTIBLE
6
RETENTION $
WORXERSOOMPENSATIONANO
OTH-
TWO OR,STATIMER
EMPLOYER6I LNBILRY
ANY PROPRIETORIPARTNER ECUrnIE
E.L. EACH ACCIDENT $
EX, DISEASE - EA EMPLOYE $
OFFICER/MEMBER EXCLUDED?
Nyea
BPEGINL APRlender
PROVISIONS alloF.L.
E.DISEASE-POLICY LIMIT $
OWER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONSDED E DORSEMENTI$PECIALPROVIMMS
52,500 Per Occurrence Property Damage De U . b e
City of Rexburg
Attn: Kathy Winters
19 E Main
Rexburg, ID 83440
ACORD 28 (2001108) FAX!
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
010 DAYS WRITTEN NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH N9TICE SMALL IMPQftMj OBIJYATION OR UABIM
OACORD CORPORATION 1988
Feb 29 2008_ 3:41PM No. 0141—P. 2/
IMPORTANT
If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain polloles may
require an endorsement. A statement on this certrficate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does It
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 26 (2001108)