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HomeMy WebLinkAboutTDS 1-1-20 lDD/YYW) E(MM ACC)RCI CERTIFICATE OF LIABILITY INSURANCE DATE 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 MARSH USA INC.- NAME` - �PHONE FAX 540 W.MADISON_ INC.No.Eon: (A/C.No): CHICAGO,IL 606611 ADDRESS: Attn:Chicago.CertRequest@marsh.com I Fax:212-948-0770 INSURER(S)AFFORDING COVERAGE NAIC M CT EXP 123113 PROP _ INSURER A:Sentry Casualty Company 28460 INSURED INSURER B:Sentry Insurance A Mutual Company 24988 TELEPHONE AND DATA SYSTEMS,INC E TDS METROCOM,LLC/ INSURER C:N/A N/A 30 N.LASALLE STREET_ INSURER D: SUITE 40001 — CHICAGO,IL 60602 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: CHI.008419972.48 REVISION NUMBER: 17 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. ILTR NSD SUER WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE ( O /YEFF (POLICY E YY) B X COMMERCIAL GENERAL LIABILITY 90-02578-11 01/01/2019 01/01/2020 EACH OCCURRENCE $ 2,000,000 DAMAGE TO CLAIMS-MADE X I OCCUR PREMISES(EaENTE occur ence) S 2,000,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG S 4,000,000 OTHER: $ B AUTOMOBILE LIABILITY 90-02578-04 01/01/2019 01/01/2020 COMBINED SINGLE LIMIT $ 5,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 90-02578-01(DED)(AOS) 01/01/2019 01/01/2020 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER A ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N 90-02578-02 01/01/2019 01/01/2020 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? N N/A (Mandatory In NH) (MA,NY,WI,ND,OH,WA,WY) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Re:Annual License,Citywidell City of Oshkosh,and its officers,council members,agents,employees and authorized volunteers is/are included as additional insured as respects operations performed by or on behalf of the named insured as required by written contract. This insurance is Primary and Non-Contributory over any existing insurance and limited to liability arising out of the operations of the Named Insured and where required by written contract. CERTIFICATE HOLDER CANCELLATION City of Oshkosh". SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 215 Church Avenue- THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Oshkosh,WI 54901 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee J�Av�ao� ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD