HomeMy WebLinkAboutBerndt Excavating 1-1-20 ACc �® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD(yYYY)
01/14/2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER
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.
I IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poiicy(ies) must 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
NAY1E: JIMCMITCHELL
MITCHELL INSURANCE AGENCY PHONE
.1�c.tle.�at1: 920-233 0272 FAX 920-233-2712
1924 S.WASHBURN ST. E-MAIL im mit tArc,No
OSHKOSH,WI 54904 ADDREss; I ® chetlinsurance.org
INSURER(S)AFFORDING COVERAGE NAIC I
INSURED INsuRERA: WILSON MUTUAL INSURANCE COMPANY
BERDNT EXCAVATING INSURER a
1264 COUNTY RD FF INSURER C:
INSURER O
OSHKOSH,WI 54904
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
LTR TYPE OF INSURANCE A L BR' I POLICY EFF .I POLICY EXP - -
JtLSD MD I POLICY NUMBER I akiroo YYYYI (MMIDDrYYYYJ LIMITS
X COMMERCIAL GENERAL LIABILITY 1
j EACH OCCURRENCE S 1,000,000
CLAIMS-MADE OCCUR DAMAGE TO RENTED 50,000 ---
PREMISES(Ea occurrence) S
A - MED EXP(Arty one person) s 5,000
_ 4000013362 01/01/2019 01/01/2020 PERSONAL a ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: I _--
GENERALAGGREGATE S 2,000,000
POLICY ( J LCC PRODUCTS-COMP/OP AGO f 2,000,000
OTHER
xj JECTS -
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000
1(Ea accldern)
X ANY AUTO BODILY INJURY(Per person) S _
A AUTToOSmlED UTAUTASTOS ED 4000013362 01/01/2019 01/01/2020 BODILY INJURY(Per accident) 5
HIRED AUTOS NON-OWNED
AUTOS OPEIOAMAGE S
•
UMBRELLA LIAR OCCUR I- .
EACH OCCURRENCE S
EXCESS LIAR
CLAIMS-MADE
AGGREGATE 5
DED f-I RETENTION S
WORKERS COMPENSATION S
PER AND EMPLOYERS'LIABILITY STATUTE j ERH_
ANY PROPRIETOR/PARTNER,EXECUTE IV •
A OFF ICERIMEMB:REXCLUDED? NIA 4000013362 ;01/01/2019 01/01/2020 E.L EACH ACCIDENT s.100,000
YI N
(Mandatory In NII)
Ifdescribe under i i 'EL DISEASE-En EMPLOYEE, S 100,000
DESCRIPTION OF OPERATIONS below
EL DISEASE-POLICY LIMIT 5 500.900
1
1 I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORO 101,Additional Remarks Schedule,may be attached If more space Is to gutted)
ADDITIONAL INSUREDS PER ATTCHEC ENDORSEMENTS.
CERTIFICATES OF INSURANCE ACCEPTABLE TO THE CITY OF OSHKOSH SHALL BE SUBMITTED PRIOR TO COMMENCEMENT OF THE WORK TO
THE APPLICABLE CITY DEPARTMENT.THESE CERTIFICATES SHALL CONTAIN A PROVISION THAT COVERAGE AFFORDED UNDER THE POLICIES
WILL NOT BE CANCELED OR NON RENEWED UNTIL AT LEAST 30 DAYS'PRIOR WRITTEN NOTICE HAS BEEN GIVEN TO THE CITY CLERK-CITY OF
OSHKOSH.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CITY OF OSHKOSH ACCORDANCE WITH THE POLICY PROVISIONS.
215 CHURCH AVENUE
PO BOX 1130 AUTIIORI RESENTAT1VE
OSHKOSH,WI 54903-1130 c
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