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NORTFUE41 ZF I ACO� i CERTIFICATE OF LIABILITY INSURANCE 11DATE (/1120MWDD MM/DD/YYYY)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 Ileu of such endorsements . PRODUCER C ACT Butte Office (AHIIC70 Ex<): (406) 494-8000 jAle, Ne :(406) 494-7641 PayneWest Insurance, a Marsh McLennan Agency LLC Company PO Box 3089 S• Butte, MT 59702 INSURERS AFFORDING COVERAGE NAIC # INSURER A : Westchester Surplus Lines Insurance Co 10172 INSURED INSURER 8 : Liberty Mutual Insurance Company 23043 Nwestco LLC dba Northwest Fuel Systems, INSURER C : Ohio Casualty Insurance Company 24074 ANC Vehicle Wash, Petrol Services 115 Industrial Court INSURER D : Evanston Insurance Company 36378 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, INSR TYPE OF INSURANCE - ADDL SUBR POLICY NUMBER POLICY EFF POLIjm � CY EX LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 210000000 CLAIMS-MADE rX OCCUR 628147545 003 9130/2020 9/30/2022 DAMAGE TO RENTEDnceI $ 250,000 MED EXP (Any oneperson) $ 51000 PERSONAL & ADV INJURY $ 21000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 21000,000 POLICY 1X jPeT F] LOC PRODUCTS - COMPIOP AGG S 2/0001000 OTHER: S B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 100000000 accident) _ ANY AUTO BAW57384241 10/30/2021 10/30/2022 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY X AUTOS y��D BODILY INJURY Per accident S AUTOS ONLY AUTOS ONLY 08E�t AMAGE $ S A UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 4,0001000 X EXCESS LIAB CLAIMS-MADE 628147557005 9130/2021 9/30/2022 AGGREGATE DED RETENTIONS Aggregate $ 4,0001000 C WORKERS COMPENSATIONPER OTH- AND EMPLOYERS' LIABILITY TER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN XWS57384241 10/30/2021 10130/2022 E.L. EACH ACCIDENT $ 11000,000 QFFICERIMEMgEtEXCLUDED? NIA 1 (mandatory in NHJ E.L. DISEASE - EA EMPLOYE ,000,000 It yes, describe under 110001000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT D Commercial Excess LI MKLV2EFX100575 9/30/2021 9/30/2022 Excess Liability 2,0009000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES JACORD 101 , Additional Remarks Schedule, may be attached K more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ATE NO To Whom It May Concern ACCORDANCE WITH TH POLICY PROVISIONgCE WILL BE DELIVERED IN t AUTHORIZED REPRESENTATIVE ACORD 26 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD