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HomeMy WebLinkAboutAl Dix Concrete 3-1-20 ACL RD CERTIFICATE OF LIABILITY INSURANCE DAT3(MMID1 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: Mary McLennan Spectrum Insurance Group GB PHONE g20 884 2850 FAX No):g20-8842851 303 Packer-land Dr., Ste C (A/c.Ns�! Green Bay WI 54307 E4AAless: Mary.McLennan@spectruminsgroup.com INSURER(S)AFFORDING COVERAGE NAIC It _ INSURER A:Sentry Insurance INSURED ALDIX-1 Al Dix Concrete, Inc. INSURER 6: 500 Draper Street I v INSURER C: Kaukauna WI 54130 INSURER 0: n T 1' I I ( i 1. O I:l- INSURER E .S I N INSURER F: COVERAGES CERTIFICATE NUMBER:1682023631 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 ADM OF INSURANCE AD SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER IMM/DD/YYYY1 (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y A0124560004 3/1/2019 3/1/2020 EACH OCCURRENCE $1,000,000DAMAGE TO CLAIMS-MADE X OCCUR PREMISES a ES( ENTED occurrence) $50,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY X jE f X LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY A0124560001 3/1/2019 3/1/2020 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ANY AUTO BODILY PURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ _ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ A X UMBRELLA LIAR X OCCUR A0124560006 3/1/2019 3/1/2020 EACH OCCURRENCE $3,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 _ DED X RETENTION$n $ A WORKERS COMPENSATION A0124560005 3/1/2019 3/1/2020 X oTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $100,000 OFFIC ER/MEMBE R EXCLU DED7 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) The City of Oshkosh,its officers,council members,agents,employees or authorized volunteers are included as Additional Insured on a primary and non-contributory basis with a 30 day notice of cancellation subject to insurance laws for the State of Wisconsin CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Oshkosh 215 Church Ave Oshkosh WI 54903-1130 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD