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HomeMy WebLinkAboutMartell Construction 2-1-20 ® DATEiMM8/DCGIYNYY'I ��� CERTIFICATE OF LIABILITY INSURANCE 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). c Clt PRODUCER CONTACT NAME: Aon Risk Services Central, Inc. PHONE (920) 437-7123 FAX (920) 431-6345 m Green Bay WI office RECEIVLL (NC.No.Cot): (A/C.No.): -O 111 N. Washington Street, Suite 300 E-MAIL O P. 0. Box 23004 ADDRESS: _ Green Bay WI 54305-3004 USA _ FR -A Ill tV' INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: ACUITY, A Mutual Insurance Company 14184 Mart1220ell Hurlbuttstreetn Inc. DEPT OF PUBLIC WO , INSURER& , Green Bay WI 54303 USA OSHKOSH.IKOSI I, WISCQN` INSURER C: INSURER 0: • INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570074941772 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. Limits shown are as requested INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POUCY NUMBER (MMIDDM/YY11 IMMIDDIYYYY) OMITS A X COMMERCIAL GENERAL LIABIUTY L54414 02/01/2019 02/01/2020 EACH OCCURRENCE $1,000,000 General Li abi l i ty DAMAGE IC)RENTED $250,000 1 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) MED EXP(Any one person) S10,000 PERSONAL BADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE 53,000,000 c POLICY 1 X I,PEITTIII X I LOC PRODUCTS-COMP/OP AGG S3,000,000 o OTHER: N- A AUTOMOBILE LIABIUTY L54414 02/01/2019 02/01/2020 COMBINED SINGLE LIMIT $1,000,000 `n Auto Liability (Ea accident) ,. 0X..i ANY AUTO Z OWNED '—'SCHEDULED REVISED CERTIFICATE: Certificate dated BODILY INJURY(Per person) BODILY INJURY(Per accident) y AUTOS ONLY AUTOS PROPERTY DAMAGE isi X HIREDAUTOS x NON-OWNED 1/10/2019 is hereby null and void. (Per accident) U ONLY AUTOS ONLY t= df A X UMBRELLAUAB X OCCUR L54414 02/01/201902/O1/2020 EACH OCCURRENCE $6,000,000 U Umbrella AGGREGATE $6,000,000 EXCESS LIAR CLAIMS-MADE DED RETENTION A WORKERS COMPENSATIONAND L54414 02/01/2019 02/01/2020 x STATUTEPER ERH EMPLOYERS'UABILITY YIN workers Compensation ANY PROPRIETOR/PARTNER 1 EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S1,000,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000— DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) - RE: SIDEWALK LICENSE. ADDITIONAL INSURED ON THE GENERAL LIABILITY AUTO AND UMBRELLA POLICIES ON A PRIMARY NONCONTRIBUTORY BASIS THE CITY OF OSHKOSH, ITS OFFICERS, COUNCIL MEMBERS, AGENTS, EMPLOYEES OR AUTHORIZED VOLUNTEERS AS RESPECTS THE WORK BEING DONE PER BLANKET ADDITIONAL INSURED ENDORSEMENT. ENDORSED POLICIES WILL INCLUDE A 30 DAY NOTICE OF CANCELLATION/NONRENEWAL FOR ANY . REASON OTHER THAN NONPAYMENT OF PREMIUM, PROVIDED TO THOSE PARTIES INDICATED IN THE WRITTEN CONTRACT. 0...■ a—J �!l Jr-. CERTIFICATE HOLDER CANCELLATION zav— SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. t+ t`� CITY OF OSHKOSH AUTHORIZED REPRESENTATIVE 00. ATTN: CITY CLERK 215 CHURCH AVENUE � � ig Po BOx 1130 ��y�r{Q(+� OSHKOSH WI 54902 USA 6GLICd ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD