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NORTFUE-01 ZFRIEZ ACORO" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) `•- -� 1111 /2021 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(ies) must have ADDITIONAL INSURED provisions or 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). PRODUCER CONTACT NAME: Butte Office PHONE PAX PayneWest Insurance, a Marsh McLennan Agency LLC Company AAIC, No, Ext): (406) 494-8000 (A/C, No):(406) 494-7641 PO Box 3089 E-MAIL Butte, MT 59702 ,.,..,I".� ,.., .�. � � .,.,,. L INSURED Nwestco LLC dba Northwest Fuel Systems, ANC Vehicle Wash, Petrol Services 115 Industrial Court Kalispell, MT 59901 COVERAGES CERTIFICATE NUM6ER� Liberty Mutl Ohio Cas_ua Evanston In Insurance Com_ ance Comaanv REVISION NUMBER: 53 74 CFRTIFICATF HOI f]FR CANCFI 1 ATION 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 L TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF DD POLICY EXP M DD Y LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 21000'000 CLAIMS -MADE OCCUR G28147545 003 9/30/2020 9/30/2022 DAMAGES (RENTED PREMISES (RENTED 250,000 250,000 $ MED_EXP_(Any one person $ 57000 _ PERSONAL BADV INJURY $ 21000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 210007000 POLICYX PE — LOC PRODUCTS -COMP/OP AGG $ _ _ 21000'000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _(Ea accident)_ _ 110001000 $ _ _... ANY AUTO BAW57384241 10/30/2021 10/30/2022 BODILY INJURY fPer person) $ OWNEDSCHEDULED AUTOS ONLY X AUTOS BODILY INJURY Per accidentl $ HIRED NPN-OWNEp AUTOS ONLY —_. AUTOS ONLY PROPERTY AMAGE (Per accident $ A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 41000'000 X EXCESS LIAB CLAIMS -MADE G28147557 005 9/30/2021 9/30/2022 AGGREGATE $ DED I I RETENTION $ Aggregate 4,000,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICERIMEMBER EXCLUDED? ECUTIVE Yrs (Mandatory in NH) a I( yes, describe under DESCRIPTION OF OPERATIONS below N / A XWS57384241 10/30/2021 10/30/2022 STATVLE ETH -- — E.L. EACH ACCIDENT __ E_L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT ---- 11000,000 $_,,,__ 11000,000 I $ 1'000'000 D Commercial Excess Li MKLV2EFX100575 9/30/2021 9/30/2022 Excess Liability 21000,000 i DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) CFRTIFICATF HOI f]FR CANCFI 1 ATION i' ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE To Whom It May Concern Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE i' ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD