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HomeMy WebLinkAboutACME Trenchless Utilities 4-17-19 ACMEWOR-01 CMULLOWNEY ACORCY MM/D(DATE D/YYYY) CERTIFICATE OF LIABILITY INSURANCE oMMlDois PHIS 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). CONTACT PRODUCER NAME: The Diedrich Agency (A/C"No,Ext (920)748-2811 FAX 920 748-5044 222 Blackburn St ( L )` (A/C,No):( Ripon,WI 54971 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC N INSURERA:Berkley Regional Specialty Insurance Company INSURED INSURER B:Progressive 16322 ACME Trenchless Utilities LLC INSURERC: 844 Ransom St INSURER D: Ripon,WI 54971 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DD/YYYYI (MM/DD/YYY� A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X BPK0101166 04/09/2018 04/09/2019 POREMIBES ElYNT rrDence) $ 100,000 X CG 2010 MED EXP(Any one person) $ 5,000 X CG 20 37 PERSONAL&ADV INJURY $ 1,000,000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X lj a LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ COMBINED SINGLE LIMIT 1,000,000 B AUTOMOBILE LIABILITY (Ea accident) X ANY AUTO X 07528288-0 04/17/2018 04/17/2019 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY X AUTOSSyyN BODILY INJURY(Per accident) $ AU- TOS ONLY AUTOS ONLY PROPERTY Per a accident)DAMAGE A X UMBRELLA LIAB ■ OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS UAB CLAIMS-MADE X CU0101275 04/09/2018 04/09/2019 AGGREGATE $ 2,000,000 DED X RETENTION$ 10,000 Personal&Adve $ 2,000,000 • WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ Q_FFICERIMEMMgEER EXCLUDED? N/A ( andatory m NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) Additional Insured per attached endrosements. Additional insured includes City of Oshkosh, and its officers,council members,agents,employees and authorized volunteers. Certificate provides 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 of the City of Oshkosh. RECEIVED MAY222018 CERTIFICATE HOLDER CANCELLATION • I fare Ct£+^ ,s oFFICF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CityACCORDANCE WITH THE POLICY PROVISIONS. Attn: City Clerk 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