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HomeMy WebLinkAboutGriese Construction of the Fox Valley 5-11-20 AC'REP CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOJYYYY) t,`.----- 5/7/2019 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 Ella Tokarski g LV i- NAME: Ella Tokarski MAY E�tJ: 715-252-7424 (AC,No)[ 920-921-5834 101 Wisconsin American Drive,Suite 300 OF {,Ut3LIC \l g ASS: etokarski@ruraliins.com DOS h )pT ��{ WIC V�i V INSURER f S)AFFORDING COVERAGE NAIC A Fond du Lac WI 54937 INSURERA: Rural Mutual Insurance j 15091 INSURED INSURER B: 1 Griese Construction of the Fox Valley,LLC. INSURER C: 606 State Rd 91 INSURER D: _ 1 INSURER E: Oshkosh WI 54904 INSURER F: I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 1 HIS 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 Ab&L'SuBRT POLICY EFF II POLICY EXP LTR TYPE OF INSURANCE INSD'WVD I POLICY NUMBER �(MM/DDlYYYY) (MWDO/YYYY) ITS X I COMMERCIAL GENERAL LIABILITY I 2,000,000 1} I I EACH OCCURRENCE S 1 CLAIMS-MADE (X III DAMAGE TO RENTED 100,000 OCCUR I PREMISES(Ea ocoarancal $— . MED EXP(Any one person) $ 5,000 A hi BOPG122698 5/11/2019 5/11/2020 PERSONAL aADVINJURY _S 1,000,000 GEN•L AGGREGATE LIMIT APPLIES PER- GENERAL AGGREGATE $ 2,000,000 riXIPOLICY I JEo- _ , LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER S AUTOMOBILE LIABILITY ( iCOMBINED SINGLE LIMIT IS 1,000,000 (Ea accident) i ANY AUTO • BODILY INJURY(Per person) $ OWNED ' SCHEDULED A X BAPG122710 5l1112019 5/11/2020 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS � HIRED 1 NON-OWNED PROPERTY DAMAGE S j AUTOS ONLY 'AUTOS ONLY /Per accident) - , t S i UMBRELLA LIAR :X OCCUR i EACH OCCURRENCE $ I--— - A EXCESS UAB CLAIMS-MADE' 0/0/0000 0/0/0000 AGGREGATE $ DED ,X RETENTIONS 10,000 S PER 1OTH- ND WORKERS COMPENSATION ,X i STATUTE ,ER AND EMPLOYERS'LIABILITY y J N � -- 1 + ANYPROPRIETORIPARTNERIEXECUTIVE E W E.L.EACH ACCIDENT 1$ 1,000,000 A OFT ICERimEMBEREXCLUDED? Y I N/A I RKG122712 5/11/2019 5/11/2020 f- (Mandatory NH) E.L.DISEASE-EA EMPLOYEE$ 1,000,000 i DESCRIPTION OF OPERATIONS below I f EL DISEASE-POLICY LIMIT!$ 1,000,000 i 0/0/0000 0/0/0000 DESCRIPTION OF OPERATIONS/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 listed as additional insured on all Liability policies for any occurence arising out the project work. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Oshkosh ACCORDANCE WITH THE POLICY PROVISIONS. Attn:City Clerk AUTHORIZp RE?RESENTATIVE PO Box 1130 Oshkosh WI 54903 �/� I _ fZ (4,6,1 ©1988-2015 ACOR - RPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD