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HomeMy WebLinkAboutKeller 1-1-20 ACORO0 DATE(MM/DD/YYYY) CC CERTIFICATE OF LIABILITY INSURANCE 4/25/2019 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 NAME: Renee Senso Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX Appleton Center, Suite 416 (A/c, a No.Ext): 920-380-2225 - (ac,No):920-734-3637 100 W. Lawrence Street ADDRESS: Renee Senso@ajg.com Appleton WI 54911 INSURER(S)AFFORDING COVERAGE NAIC a INSURER A:Travelers Property Casualty Co of America 25674 INSURED INSURER B: Indian Harbor Insurance Company 36940 KELLER INC N216 HWY 55 INSURER C:AGCS Marine Insurance Company 22837 KAUKAUNA WI 54130-8401 INSURERD:Phoenix Insurance Company 25623 INSURER E:Travelers Indemnity Co of America 25666 INSURER F: COVERAGES CERTIFICATE NUMBER:1236950740 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 ADDINSD TYPE OF INSURANCE WVD SUER POLICY EFF POLICY EXP LTR POLICY NUMBER (MM/DD/YYYY) (MM DD/YYYY) LIMITS , INSD D X COMMERCIAL GENERAL LIABILITY Y VTN-CO-6E000246-PHX-19 1/1/2019 1/1/2020 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $300,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X FEC X LOG PRODUCTS-COMP/OP AGO $2,000,000 OTHER: Total Aggregate $10,000,000 E AUTOMOBILE LIABILITY VTH-CAP-6E000314-TIA-19 1/1/2019 1/1/2020 EaOMBINEDSINGLEaccident) LIMIT $1,000,000 ( X ANY AUTO BODILY INJURY(Per person) $ x OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS I x HIRED x NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) Comp/Coll $$1,000/$1,000 A X UMBRELLA LIAR X OCCUR VTSMJ-CUP-6E000326-TIL-19 1/1/2019 1/1/2020 EACH OCCURRENCE $25,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $25,000,000 DED X RETENTION$1nL(1(lf) $ A WORKERS COMPENSATION UB-1L788830-19-25-H 1/1/2019 1/1/2020 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 II yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 B Professional/Pollution Liability CE0744687502 1/1/2019 1/1/2021 Limit 2,000,000 C Contractors Equipment MXI93079544 1/1/2019 1/1/2020 Limit/Deductible $1,839,454/$5,000 C Leased/Rented Equipment MXI93079544 1/1/2019 1/1/2020 Limit/Deductible $250,000/$5,000 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) The Umbrella policy follows form over all policies except for the Professional Liability. City of Oshkosh,and its officers,council members,agents,employees and authorized volunteers are Additional Insured as respects to the General Liability policy, pursuant to and subject to the policy's terms,definitions,conditions and exclusions. Insurance is Primary and Non-contributory.30 Days Notice of Cancellation applies on General Liability. 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 215 Church Avenue PO Box 1130 AUTHORIZED REPRESENTATIVE Oshkosh WI 54903-1130 J 1 dko-( 64-trq. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD