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HomeMy WebLinkAboutCERTIFICATION OF LIABILITY INSURANCE - 08-00214 - Madison Memorial Hospital VIP Grand Opening,AC MDT, CERTIFICAT" ®F LIABILITY INSURAI'l DATE /z o PRODUCER (208)524-5858 FAX (206) 522-8049 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA'riON DD'L NSR TYPE OF INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE I Egan, Metcalf & Leavitt POLICY EXPIRATION DATE MM1DD HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 3780 N. Yellowstone ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Box 2498 06/05/2007 06/05/2008 Idaho Falls, ID 83403 INSURERS AFFORDING COVERAGE NAIC # INSURED Elite Pyrotechnics, LLC INSURERA-. National Fire & Marine 20079 217 N 3rd West DAMAGE TO RENTED r1ce $ 100,000 INSURER B: Scottsdale Insurance Company 41297 Rexburg, ID 83440 CLAIMS MADE P(I OCCUR INSURER C. INSURER D' A INSURER E. (`(1\/G R A C. GS 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ]NSR LTR DD'L NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD POLICY EXPIRATION DATE MM1DD LIMITS GENERAL LIABILITY 72LPS001171 06/05/2007 06/05/2008 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED r1ce $ 100,000 CLAIMS MADE P(I OCCUR MED EXP (Any one person) $ 5,000 A PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELIMITAPPLIESPER -. PRODUCTS - COMP/OPAGG $ EXCLUDED_ POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO $ EXCESSIUMBRELLA LIABILITY TBD 06/05/2007 06/05/2008 EACs -t OCCURRENCE $ 2,000,000 X OCCUR CLAIMS MADE AGGREGATE $ B 2000000 $ 2,000,000 DEDUCTIBLE X RETENTION $ 10,000 - $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS' LIABILITY TORY LIMITS ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT] SPECIAL PROVISIONS E: Insureds Operations City of Rexburg 12 N. Center Rexburg, ID 83440 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Jaime Bradley/JB AGUKU Zt, (ZUU1/08) rriA. �cL)0)5D!1 suL[ ©ACORD CORPORATION 1988 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 policies may require an endorsement. A statement on this certificate 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. frwrcv'do �Zuulruts)