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HomeMy WebLinkAboutS&S Excavating 4-3-20 S&SEXCA-01 MHOBBS ,d►CORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 7/24/2019 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 C NTACT N ME: The Diedrich Agency ac,NNo,Ext (920)232-4090 I FAX(NC No):(920)748�044 303 High Avenue LE�Mq�L Oshkosh,WI 54902 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:United Fire&Casualty 13021 INSURED INSURER B: S&S EXCAVATING INSURER C: MARK SCHUELKE N6256 CTY ROAD 0 INSURER D: MANAWA,WI 54949 INSURERS: 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 IMMIDDIYYYYj,(MMIDD/YYYYI A X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE _ S 1,000'000 CLAIMS-MADE X OCCUR 60475075 4/3/2019 4/3/2020 PREMISDAMAGEES l TOEa RENTEDoccurtence) $ 200,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY X JECT X LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: S • A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ _.._ X ANY AUTO 60475075 4/3/2019 4/3/2020 BODILY INJURY(Per person) $ OWNED SCHEDULED AURTEO�S ONLY _ AUTOS WN p BODILYO INJURY(Per accident) $ AUTOS ONLY AUUTOS O (PerrNLY a deneMAGE A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 1,000,000 EXCESS UAB CLAIMS-MADE' 60475075 4/3/2019 4/3/2020 AGGREGATE S 1,000,000 DED X RETENTIONS 10,000' S A AND EMPLOYERS'LIABIUT KERS NY YIN STATUTE ER PER H ANY PROPRIETOR/PARTNER/EXECUTIVE 60475075 4/3/2019 4/3/2020 E.L.EACH ACCIDENT $ 1,000,000 FICER/ME M EXCLUDED? Y N I A (Mandatory In NH) 1,000,000 E.L.DISEASE-EA EMPLOYEE S If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) Mark Schuelke and Arthur Schuelke are excluded from coverage under workers compensation Additional Insured Status has been added for the City of Oshkosh under the General Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Oshkosh-Public Works THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Engineering Division PO Box 1130 Oshkosh,WI 54901-4747 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD