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HomeMy WebLinkAboutGabes Construction Company 7-1-20 ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDlVYYY) ‘et......----- 6/18/2019 i HIS 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 chris tine.miramontes NAME: R&R Insurance Services Inc PHONE (262)574-7000 FAX (262)574-7080 (A/C.No,Emi: (AIC,No): N14 W23900 Stone Ridge Drive RECEIVED E-MDREss:chriatine.miramontes@rrina.com INSURER(S)AFFORDING COVERAGE NAIC 8 Waukesha WI 53188 INSURERA:Charter Oak Fire Ins Co (Travelers) 25615 INSURED JUN 2 4 2019 INsuRERa:Travelers Indemnity Company of CT 25682 Gabes Construction Companyan Oh' PUBLIC WORKS INSURER C:Travelers Indemnity Company 25658 4804 N 40th St nS- KOWH, WISCONSIN INSURERD:Continental Insurance Co (CNA) 35289 PO Box 385 INSURERE: Sheboygan WI 53082-0385 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1961892037 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 I 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 ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSO INVn POLICY NUMBER (MM/DD/YYYYI (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED A CLAIMS-MADE X OCCUR PREMISESO(Eaoccurrence) $ 300,000 CO-9K367898 7/1/2019 7/1/2020 MED EXP(Any one person) $ 10,000 CGD604 02-19 (AI) PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: CGT100 02-19 (PNC) GENERAL AGGREGATE $ 2,000,000 _ POLICY PRO - POLICY JECT LOC CGD316 02-19 (NOS) PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 810-9E288207 7/1/2019 7/1/2020 BODILY INJURY(Per accident) $ _ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS CAT474 02-16 (AI/PNC) (Per accident) CAT353 02-15 (NOS) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 20,000,000* C EXCESS LIAB CLAIMS-MADE CUP-9E369055 (Lead $10M) 7/1/2019 7/1/2020 AGGREGATE $ 20,000,000* DED X RETENTION$ 10,000 EU0001 07-16 (AI/PNC/WOS) $ WORKERS COMPENSATION X PER ERH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A B (Mandatory in NH) UB-8E449046 7/1/2019 7/1/2020 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes describe under DESCRIPTION OF OPERATIONS below i ,E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Installation Floater 660-ID65560A 7/1/2019 1 7/1/2020 I Any One Jobsite 1,000,000 Leased/Rented Equipment 660-ID65560A 7/1/2019 7/1/2020 Any One Item 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Oshkosh and its officers, council members, agents, employees and authorized volunteers are Additional Insured for General Liability (includes ongoing & completed operations) and Auto Liability (per forms above) on a primary and non-contributory basis as required by contract. 30-Day Notice of Cancellation applies in favor of the certificate holder; except for non-payment of premium. 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 Department of Public Works ACCORDANCE WITH THE POLICY PROVISIONS. & City Clerks Office 215 Church Avenue AUTHORIZED REPRESENTATIVE PO Box 1130 Oshkosh, WI 54903-1130 Thomas Scheider/DM586 = ---- __ '� � " ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)