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HomeMy WebLinkAboutSurface Creations 5-26-20 A ® DATE(MMIDDIVYVY) CERTIFICATE OF LIABILITY INSURANCE 06/12/2019 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 Becky Keitel,CIC NAME: Keitel Group Insurance,Inc HO,NE Eat): 244-1146 FAX X No): (608)244-2640 N3880 Steven Drive E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 0 DeForest WI 53532 INSURER A: West Bend 15350 INSURED INSURER B: Surface Creations,Inc INSURER C: H&H Pools&Spas INSURER D: PO Box 486 INSURER E: Montello WI 53949 INSURER F: COVERAGES CERTIFICATE NUMBER: Master 2019-2020 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 AWL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD_ POLICY NUMBER (MMIDDIVYYY) (MMIDDIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO RENTED $ 1,000,000 CLAIMS-MADE n OCCUR PREMISES(Ea occurrence) $ 300,000 MED EXP(Any one person) $ 10,000 A 1739617 05/26/2019 05/26/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. GENERAL AGGREGATE $ 2,000,000 POLICY n PE� n LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ - A OWNED SCHEDULED 1739617 05/26/2019 05/26/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ X UMBRELLA LIAR OCCUR EACH OCCURRENCE $- 1,000,000 A EXCESS LIAB CLAIMS-MADE 1739617 05/26/2019 05/26/2020 AGGREGATE $ 1,000.000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER v/N 100,000 A ANYPROPRIETOR/PARTNER/EXECUTIVE ri N I A 1739618 05/26/2019 05/26/2020 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if moms space is required) City of Oshkosh,and its officer,council members,agent,employees and authorized volunteers are additional insured on a primary and non contributory basis. CERTIFICATE HOLDER CANCELLATION 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. 215 Church Ave AUTHORIZED REPRESENTATIVE PO Box 1130 Oshkosh WI 54903 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD