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HomeMy WebLinkAboutD R Hansen Plumbing 1-1-20 DRHANSE-01 SSELL AC-oRo CERTIFICATE OF LIABILITY INSURANCE DATE iMM/DD/YYYY) �.� 1/21/2019 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 Sarah Sell NAME: The Insurance Center PHONE FAX 920 Association Drive W (NC,No,Ed):(800)944-1367 51137 (AMC,No): Appleton,WI 54914 mass:ss:ssell@ticinsurance.com - INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Integrity Select _ 10288 INSURED INSURER B:Integrity Mutual Insurance Co 14303 D R Hansen Plumbing LLC INSURERC: 55 Knapp St INSURERD: Oshkosh,WI 54902 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMWDD/YYYYI (MM/DDIYYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CPP2772885 1/1/2019 1/1/2020 DAMAGETORENTED 300,000 PREMISES{Ea occurrence) $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY j 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JE 9j X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ COMBINED SINGLE LIMIT 1,000,000 B AUTOMOBILE LIABILITY {Eacid acent) X ANY AUTO CA 2772882 1/1/2019 1/1/2020 BODILY INJURY(Per person) $ AUTEOS ONLY SCHEDULED _BODILY INJURY(Per accident) $ AUTOS ONLY NON-OWNEDS PROPERTY(DAMAGE (Per accident) B X UMBRELLA LIAB X OCCUR 5,000,000 EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE CUP2772884 1/1/2019 1/1/2020 AGGREGATE $ 5,000,000 DED RETENTION$ $ B WORKERS COMPENSATION PER X OTH- AND EMPLOYERS'LIABILITY STATUTE ER WCP2772883 1/1/2019 1/1/2020 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE l E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A ' (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yen,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B ,Equipment Floater CPP2772885 1/1/2019 1/1/2020 Installation Floater 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Please see Remarks on page 2. Re:Street/sidewalk obstruction/excavation work in right-of-way City of Oshkosh and its officers,council members,agents,employees and authorized volunteers are additional insureds on the general liability and auto policies when required by written contract or agreement.For reasons other than non-payment of premium or insured's request,30 days'notice will be provided to the certificate holder in the event that the issuing company cancels the general liability policy before the expiration date of the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Ave Oshkosh,WI 54901 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD