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Home My WebLink AboutDelrar 4-1-20 DATE(MM10D/YYYY) .ACORE' CERTIFICATE OF LIABILITY INSURANCE ki.—/ 5/23/2019 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 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 Dawn Baker NAME: _ R&R Insurance Services Inc PHONE 262-338-7879 FAX 262-33B-7B79 (A/C,No,F.xty (A/C.Not: 2021 S 18th Avenue Suite 202 LA F,I� I h E-MAIL ADDRESS Dawn.BakerQrrias.com PO Box 914 INSURER(S)AFFORDING COVERAGE NMC• Nest Bend WI 53095 V O 3 2019 INsuRErtA:Acuity A Mutual Ins Co 14184 INSURED INSURER B: Delrar Inc DEPT OF I'1113LIt' wORkS INSURER C: N136 Two Mile Rd OSHKOSH, MSC()NSIN INSURERD: INSURER E: Appleton WI 54 914 INSURER F: COVERAGES CERTIFICATE NUMBER:19/20 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. DOR ADM OF INSURANCE AD SUBR" POLICY EFF POLICY EXP UNITS LTR INSD WVD POLICY NUMBER (MM!DDIYYYY) IMMIDD#YYYYI' X COMMERCIAL GENERAL LIABILITY Z93723 4/1/2019 4/1/2020 EACH OCCURRENCE $ 1,000,000 A I J CLAIMS-MADE [it]OCCUR PREMISES(E occurrence) S 250,000 X Blanket AI Ongoing Ops X CP7191 (05/13) MED EXP(Any one person) $ 10,000 X Blanket AI Capp Ops PI(C CP7242 (05/13) PERSONAL&ADVINJURY S 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY X 1 jE Loc ,PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: Voluntary Property Damage $ 5.000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 _ (Ea accident) A X ANY AUTO i BODILY INJURY(Per parson) $ ALL OWNED SCHEDULED AUTOS AUTOS X Z93723 4/1/2019 i 4/1/2020 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X_ AUTOS (Per accident)_ $ I X IAddtlInsd CA7214 (10/98) LJnsIted motorist BI split limit $ 1,000,000 , X UMBRELIALIAB X OCCUR Z93723 4/1/2019 4/1/2020 EACH OCCURRENCE $ 5,000,000 A EXCESSIJAB ' CLAIMS-m DE Addtl Znad CU7098 (11/15) -AGGREGATE $ 5,000,000 DED I I RETENTION S 0 I $ WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY YIN STATUTE ER _ ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ _ 100,000 OFFICER/MEMBER EXCLUDED? N NIA A Z93723 4/1/2019 4/1/2020 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEES 100,000 If yes,describe under i DESCRIPTION OF OPERATIONS below ;E.L DISEASE-POUCY LIMIT $ 500.000 I I , DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Oshkosh and any others required by the contract are additional insureds for General Liability including ongoing & completed operations and Auto Liability per forms listed above when required by written contract. 30-day notice of cancellation applies for reasons other than non-payment. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Ave PO Box 1130 AUTHORIZED REPRESENTATIVE Oshkosh, WI 54903-1130 / S VanLaanen/DB530 <<�� _� �/ Lam' ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)