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HomeMy WebLinkAboutCapelle Brothers & Diedrich 1-1-20 CAPEBROOPC MHEESE ,.4COR0 DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1/5/2019 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 Michael T Foley NAME: Jackson Kahl Insurance Services, LLC 17 N Pioneer Road ja"c°,"N,Ext):(920)923-4020 1122 FAX No):(866)218-6850 Fond Du Lac,WI 54935 E-MAIL mtfoley75@gmail.com INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:West Bend Mutual Insurance Co. 15350 INSURED INSURER B: Capelle Brothers&Diedrich, Inc. INSURER C: P.O.Box 1274 INSURER D: Fond du Lac,WI 54936-1274 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 POLICY EXP LIMITS LTR INSD WVD IMM/DD/YYYY! (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 2282100 1/1/2019 1/1/2020 DAMAGE TO RENTED 300,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMITO APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: VOLUNTARY PD $ 2,500 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) X � ANY AUTO 2282100 1/1/2019 1/1/2020 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ U NON-OWNED PROPERTYDAMAGE ATOS ONLY UUTTOS ONLY (Per accident) $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAB i CLAIMS-MADE 2282100 1/1/2019 1/1/2020 AGGREGATE $ 10,000,000 DED X RETENTION$ 0 $ A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER 0570764 1/1/2019 1/1/2020 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? Y N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) The City of Oshkosh Consultants,architects,architect consultants,engineers,engineer consultants,contractors and subcontractors are as an additional insured on a primary and non-contributory basis with a waiver of subrogation under the General Liability form#CG2010Y(07/04), #CG2037(04/13),#CG2404 (05/09),under Business Auto form#CA2048(10/13). The umbrella policy includes the general liability,automobile liability and employer's liability in its underlying. Built into pi:ft(pjigabe is 30 dOys'notice of cancellation with 10 days for non-payment. JAN 0 9 2019 CERTIFICATE HOLDER CANCELLATION CITY CLERK'S OFFICE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Cityof Oshkosh Attn:CityClerk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Street I P.O.Box 1130 Oshkosh,WI 54903-1130 AUTHORIZED REPRESENTATIVE 044;7, ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD