Loading...
HomeMy WebLinkAboutL & H Gyr Excavating 8-1-20 �...40 L&HGEX1 OP ID: K3 ACORO DATE(MMIDDIYYYY) �� CERTIFICATE OF LIABILITY INSURANCE 07/23/2019 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 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 608-257-3795 CONTACT Jon Templin, CISR,CRIS Hausmann-Johnson Insurance Inc PHONE FAX 700 Regent St.,PO Box 259408 CE-VLip _lac,No,Ext):608-257-3795 1(A/c,No):608-257-4324 Madison,WI 53725-9408 i RE E Do IILEss: Jon Templin,CISR,CRIS 9 INSURER(S)AFFORDING COVERAGE NAIL N 2 6 /� INSURER A:Middlesex Insurance Co INSURED L& H Gyr Excavating, Inc. .0C , - INSURER B:Sentry Insurance 24988 629 Van Fond duDaceWld54937-1448,,PT OF P j W,SCONS�N INSURERC: - )SNKO`t ' INSURER D: - - INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 2019 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 SUBR W POLICY NUMBER M/POLICY EFF POLICY EXP LIMITS LTR INSD VD (MDDITYYY1 (MM/DD/YYYYI A X COMMERCIAL GENERAL LABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR A0059430004 08/01/2019 08/01/2020 DAMAGE TO RENTED 500,000 X PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY X ISei: LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Emp Ben. $ 1,000,000 A AUTOMOBILE WBILnY (Ea accidentSINGLE LIMIT $ 1,000,000 X ANY AUTO A0059430001 08/01/2019 08/01/2020 BODILYINJURY(Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS W Ep BODILY INJURY(Per accident) $ X AUTOS ONLY X AUTOS ONLY _(Per accident)AMAGE $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 11,000,000 EXCESS LIAB CLAIMS-MADE A0059430007 08/01/2019 08/01/2020 AGGREGATE $ 11,000,000 • DED X RETENTION$ 0 $ B WORKERS COMPENSATION X STATUTE ER H ANOEMPLOYERS'LIABILITY YIN A0059430006 1 08/01/2019 08/01/2020 500,000 ANY OFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ ,DESCn req i OPEJfA writt LOCATIONS I „tutil ESdACORD]p1,Additional Remarlls Schg Ule,may be attached if more space is required) Allen re Ulred In WIl en COntraC I e ILy oT(Js11FCosll and I s oT ICers, council members, agents,employees and authorized volunteers shall be listed as additional insureds with regard to general Iiabliity.A 30 Day Notice of Cancellation applies,with the exception of workers comp. CERTIFICATE HOLDER CANCELLATION CITYOSH 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. Office of City Clerk 215 Church Ave PO Box 1130 AUTHORIZED REPRESENTATIVE . Oshkosh,WI 54903-1130 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.