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HomeMy WebLinkAboutRaiserite Concrete Lifting 1-1-20 RAISCON-02 MWILLIAMSON ACORO DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 5/30/2019 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 Vlzance,Inc. PHONE FAX 1320 Walnut Ridge Dr.Ste.200 (A/C,No,Eat):(262)367-8611 (AIC No):(262)367-8529 Hartland,WI 53029 MSS: INSURER(S)AFFORDING COVERAGE NAIC# _ INSURER A:Acuity _ 14184 INSURED INSURER B: Raiserite Concrete Lifting Inc RaiseRite Foundation Pier INSURERC: Systems,Inc. 1025 E.Albert Dr. INSURER D: Manitowoc,WI 54220 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DDIYYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X86313 1/1/2019 1/1/2020 DAMAGETORENTED 100,000 X PREMISES IEa occurrence) S MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE pCT LIMITR�APPLIES PER: GENERAL AGGREGATE JE S 2r000,000 POLICY X LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY (Ea acciden SINGLE LIMIT $ _ 1,000,000 ANY AUTO X X86313 1/1/2019 1/1/2020 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTEO�S ONLY AUTOS yy BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS ONLY P4O rAIAGE $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE. X86313 1/1/2019 1/1/2020 AGGREGATE S 5,000,000 DED X RETENTION$ 0 S A WORKERS COMPENSATION 'MUTE EMPLOYERS'LIABILITY Y/N X86313 1/1/2019 1/1/2020 X STATUTE ER 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER FFIC Rory in BE EXCLUDED? 1,000,000 EL DISEASE-EA EMPLOYEE $ If yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re: Mudjacking to City sidewalks. The City of Oshkosh,its officers,council members,agents,employees and authorized volunteers shall be named additional insureds with regard to the General Liability and Auto Liability,as required by written contract.General Liability is on a primary and non-contributory basis,including ongoing and completed operations coverage. A 30-day Notice of Cancellation applies. All above referenced coverages are subject to actual policy forms,terms,and conditions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPTION DATE THEREOF, City of Oshkosh,Attn: City Clerk ACCORDANCE WITH THE POLICY PROVISIONSCE WILL BE DELIVERED IN 215 Church Ave. P.O.Box 1130 Oshkosh,WI 54903-1130 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD