Loading...
HomeMy WebLinkAboutWaas Boring and Cable 7-1-20 _____....,40 WAASBOROPC RZIVKOVICH ,a►`�Ro CERTIFICATE OF LIABILITY INSURANCE DAT/19/2DlYYYY) 6/19/2019 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 NAMTACT Rebecca Zivkovich, CISR Jackson Kahl Insurance Services,LLC PHONE FAx 17 N Pioneer Road (Arc,No,Ea):(800)236-5010 1128 I(NC,No):(866)218-6850 Fond Du Lac,WI 54935 r D E-MAIL rzivkovich@jacksonkahl.com __ RECEIVE ADDRESS; INSURER(S)AFFORDING COVERAGE NAIC# —_ JUN `L 4 %Q\g INSURER A:West Bend Mutual Insurance Co. 15350 INSURED INSURER B: Waas Boring and Cable,Inc. �U�� 1,C WORRiNsuRERc: N10483 Waas Road DEp�OF W�SCONS1'NSURER D: Lomira,WI 53048 KQSH, QSH INSURER E: 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 LTR. INSD WVD (MM(DD/YYYYI IMM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X 0762896 7/1/2019 7/1/2020 WREM SES NTE4nce) $ 300,000 MED EXP(My one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X j IT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER A $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO 0762896 7/1/2019 7/1/2020 BODILY INJURY(Per person) $ OWNED SCHEDULEDO BODILY INJURY(Per accident) $ _ AUTOSRE ONLY AUTNOpSyyryE X AUTOS ONLY X AUTOS ONL� (Perr accidenlDAMAGE $ 1 $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 9,000,000 EXCESS LIAB CLAIMS-MADE 0762896 7/1/2019 7/1/2020 AGGREGATE $ 9,000,000 DED X RETENTION$ 0 A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YrN 0762897 7/1/2019 7/1/2020 100,000 OFFICER/MEMBER EXCLUDED? N N rA E.L.EACH ACCIDENT $ IMandatory iin H1 100,000 E.L.DISEASE-EA EMPLOYEE $ If es,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Additional insureds per attached endorsements. Certificates of Insurance acceptable to the City of Oshkosh shall be submitted prior to commencement of the work to the applicable City Department. These certificates shall contain a provision that coverage afforded under the policies will not be canceled or non renewed until at least 30 days'prior written notice has been given to the City Clerk-City of Oshkosh. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Oshkosh,Attn:City Clerk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Street PO 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