HomeMy WebLinkAboutZillges Materials 7-1-20 ACOREP CERTIFICATE OF LIABILITY INSURANCE GATE(MM/DDIYYYY)
6/21/2019
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
Ann Wehrle
Ansay&Associates, LLC. -OSH PHONE FAX
430 N. Koeller Street tAtc.No.Ext); 920-235-2764 (A/C,No):920-235-2694
Oshkosh WI 54902 ADDRESS: ann.wehrle@ansay.com
INSURER(S)AFFORDING COVERAGE NAIC N
INSURER A:West Bend Mutual Insurance Company 15350
INSURED ZILLMAT-03
INSURER B:
Zillges Materials, Inc.
1990 W Snell Road INSURER C:
Oshkosh WI 54904 INSURERD:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:7937777 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 ADDL
SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER M/ LIMITS
(MDD/YYYY) (MMIDD/YYYY)
A X COMMERCIAL GENERAL LIABILITY 0708525 7/1/2019 7/1/2020 EACH OCCURRENCE $1,000,000
DAMAGE RENTED
1 CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $300,000
MED EXP(Any one person) $10.000
PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
POLICY X JECT LOC PRODUCTS-COMP/OP AGG $2,000,000
OTHER: $
A AUTOMOBILE LIABILITY 0708525 7/1/2019 7/1/2020 COMBINED SINGLE LIMIT $
(Ea accident) 1.000,000
X ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS X HIRED AUTOS X PROPERTY DAMAGE NON-OWNED (Per accident)
AUTOS
A UMBRELLA LIAB X OCCUR 0708525 7/1/2019 7/1/2020 EACH OCCURRENCE $5,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
A WORKERS COMPENSATION 0708526 7/1/2019 7/1/2020 PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required)
City of Oshkosh and its officers,council members,agents,employees and authorized volunteers are additional insured.
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
Oshkosh WI 54901 AUTHORIZED REPRESENTATIVE
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