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HomeMy WebLinkAboutSure Fire 2-1-20 Ilk. 'ACC,RE DATE(MM/DD/VVYY)CERTIFICATE OF LIABILITY INSURANCE 3/22/2019 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 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 Ericka Berceau NAME: R&R Insurance Services Inc PHO No (262)574-7000 FAX �).(262)574-7080 1581 E Racine Avenue RE S5:Ericka.Berceauerrins-com ADDPO Box 1610 INSURER(S)AFFORDING COVERAGE NAIC 8 Waukesha WI 53187-1610 INSURERA:West Bend Mutual Ins- Co- 15350 INSURED mums Surplus Lines Ins Co 10172 Sure Fire Inc INSURERC: _ 617 Washington Street INSURERD: PO Box 191 INSURERE: Horicon WI 53032 INSURERF: COVERAGES CERTIFICATE NUMBER:19-20 Liability Cert 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 IADDL SUER POLICY EFF POLICY EXP LIMITS LTR INSD VD POLICY NUMBER EMM/DDW MI YYY) IMDD/YYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2,000,000 DAMAGE TO RENTED A I CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $ 300,000 A400833 2/1/2019 2/1/2020 _MED EXP(Any one person) _ $ 10,000 Forma: S031482 7/17, PERSONAL 8 ADV INJURY S 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: CO2404 5/09 GENERAL AGGREGATE S 4,000,000 POLICY X PERCOT- LOC PRODUCTS-COMP/OP AGO S 4,000,000 OTHER: Errors&Omissions S 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED A400833 2/1/2019 2/1/2020 BODILY INJURY(Per accident) S AUTOS _ AUTOS X X NON-OWNED >roras: CA2048z 10-13, PROPERTY DAMAGE S HIRED AUTOS _ AUTOS (Per accident) CA0444 10/13 I I $ X UMBRELLA LIAR X OCCUR A400833 2/1/2019 2/1/2020 EACH OCCURRENCE $ 5,000,000 A EXCESS LAB CLAIMS-MADE Pores: WB1787 i/19, AGGREGATE S 5,000,000 DED RETENTIONS CO2403 9/00 S WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT ,S 500,000 OFFICER/MEMBER EXCLUDED?A f N.1 N/A (Mandatory In NH) A399652 2/1/2019 2/1/2020 E.L.DISEASE-EA EMPLOYEE S 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 B Pollution Liability 071484038 001 2/1/2019 2/1/2022 Limit 1,000,000 A Rented/Leased Equipment A400833 2/1/2019 2/1/2020 Limit 100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Oshkosh is listed as additional insured on the policy in regards to General Liability including ongoing and completed operations, on the Automobile and on the Umbrella per forms listed above, when required by written contract. 30-days notice of cancellation applies, except for non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Jon G Urben, General Services ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1130 Oshkosh, WI 54903-1130 AUTHORIZED REPRESENTATIVE Dan Maurer/EB633 F , �, ----- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025;201401l