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NORTFUE-01 ZF IEZ '4�a CERTIFICATE OF LIABILITY INSURANCE OAT111 / 0D/Y 1 1 /1 /2021 1 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(les) 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 CO T CT Butte Office PHONE FAX PayneWest Insurance, a Marsh McLennan Agency LLC Company E C. Na. Eat): 406) 494-8000 (Aro, Ne :(406) 4944641 PO Box 3089 Butte, MT 59702 INSURERS AFFORDING COVERAGE NAIL # INSURER A : Westchester Surplus Lines Insurance Co 10172 INSURED INSURERS : Llbe Mutual insurance Company 23043 ANC Vehicle Wash, Petrol Services NWBStCO LLC Northwest Fuel Systems, INSURER C : Ohio Casualty Insurance Company. 24074 116 Industrial Court INSURER D : Evanston Insurance Company 35378 Kalispell, MT 59901 INSURER E : INSURER F : 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, ILTRNSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS - A X COMMERCIAL GENERAL LIABILnY EACH OCCURRENCE S 2,000,000 CLAIMS-MADE ❑X OCCUR G28147646 003 9/30/2020 9/30/2022 DAMAGE TO eENTED S 250,000 MED EXP (Any one rson 5 51000 PERSONAL & ADV INJURY S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 2,0001000 POLICY F�X] jp&� F�] LOC PRODUCTS - COMP/OPAGG S 2,0001000 OTHER: S B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 11000, 000 c ANY AUTO BAW57384241 10/30/2021 10/30/2022 BODILY INJURY Per person) $ _ AURTEO�SDONLY X AUTNOOSyUyLNEED BODILY INJURY Per accident) S _ ATOS ONLY AUTOS M 08Edr AMAGE $ S A UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 41000,000 X EXCESS LIAB CLAIMS•MAOE G28147557 005 9/30/2021 9/30/2022 AGGREGATE S DED RETENTIONS Aggregate S 41000,000 C WORKERS COMPENSATION PER OTH- AND EMPLOYERS$ LIABILITY yyy/// NWS57384241 1013012021 10/30/2022 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT S 110001000 �FFICa 0ryJM�7) EXCLUDED? NIA Aendaory n HH)) E.L. DISEASE - EA EMPLOYE ' _5110000000 II es, d®scribe under DESCRIPTION OF OPERATIONS below 110001000 E.L. DISEASE - POLICY LIMIT S D Commercial Excess Li MKLV2EFX100575 9130/2021 9/3012022 Excess Liability 21000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE To Whom It May Concern THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) /© 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD