Certificate of InsuranceCertificate of Insurance
THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT AN
INSURANCE POLICY AND DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW.
This is to Certify that
MARTEL CONSTRUCTION INC
1203 S CHURCH
BOZEMAN, MT 59715
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Liberty(��
Member of Libcrty Mutual Group
P O. Box 4555
Portland, Oregon 97208-4555
503.239.5800
is at the date of the certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is
subject to all their terms, exclusions and conditions and is not altered by any requirement, term or condition of any contract or other document
with respect to which this certificate may be issued.
TYPE OF POLICY
EXPIRATION
POLICY NUMBER
LIMITS OF LIABILITY
DATE
COVERAGE AFFORDED TINDER W.C. LAW OF
COVERAGE AFFORDED UNDER W.C. LAW OF
FOLLOWING STATES
FOLLOWING STATES
i
® WORKERS'
Montana
7/1/05
WC4-1NC-012929 014
COMPENSATION
R05
EMPLOYERS LIABILITY LIMITS
EMPLOYERS LIABILITY LIMITS
Each Accident $500,000
Each Accident $
I
Disease — policy limit $500,000
i
Disease — policy limit S
Disease — each employee $500,000
Disease — each employee $
i
MARITIME COVERAGE— FOLLOWING STATES
MARITIME COVERAGE— FOLLOWING STATES
GENERAL LIABILITY
General Aggregate Products/Comp/OPS
$
❑Commercial General
Aggregate
$
Liability (OCCUITC11CC)
Personal & Advertising Injury
$
i � ❑Owners and
Each Occurrence
$
Contractor's Protective
Fire Damage (Any one fire)
$
❑
Medical Expense (Any one person)
$
AUTOMOBILE LIABILITY
❑ Any Auto
CSL
$
[]All Owned Autos
Bodily Injury (Per Person)
$
❑Scheduled Autos
Bodily Injury (Per Accident)
$
❑Hired Autos
❑Non -owned Autos
Property Damage
$
❑Garage Liability
❑
I
LOCATIONS) OF OPERATIONS & JOB # (IF APPLICABLE)
DESCRIPTION OF OPERATIONS
Kalispell Fire Station #62, Kalispell, MT
i
All Operations of Insured
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING {
CANCELLATION:
COMPANY WILL ENDEAVOR TO MAIL 45 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED BELOW, BUT
FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, OR
REPRESENTATIVES.
MAILED TO:
CITY OF KALISPELL
PO BOX 1997
312 1ST AVENUE EAST
KALISPELL, MT 59903
(l'�Itll) n�1�t1��Ititl��tt�lt�)
THORIZ "RS#TATIVE / LJL
6/21/2005 Bozeman, MT
DATE ISSUED OFFICE
CERTIF / Version 1.0 LNW 3004L 11/97