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HomeMy WebLinkAboutAffordable Concrete 4-26-19 TE(MWOD/YYYY)ACORDTM CERTIFICATE OF LIABILITY INSURANCE DA05/03/2018 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 BOCK INSURANCE AGENCY, INC. NAME: 2337 JACKSON ST PHONE , EH) Ex: FAX OSHKOSH, WI 54901 E-MAIL. ADDRESS Phone: 920-235-5737 Fax:920-235-7227 INSURER(S)AFFORDING COVERAGE NAIC# 14104 INSURER A Aculy.a Mutual Insurance Company INSURED INSURER N: AFFORDABLE CONCRETE INSURER C. 225 W HURON ST INSURER D- OMRO WI 54963 INSURERE: 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR wvD POLICY NUMBER (MM/DDRTTY) (MM/DD/YYW) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE 0 OCCUR DAMAGE TO RENTED $100.000 PREMISES(Ea occurence) 8is-Pak Business Liability and Medical MEO EXP(Any one person) S 5,00E Expenses L58398 04/26/2018 04/26/2019 PERSONAL&ADV INJURY Included GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2.000,000 , POLICY n ED LOC PRODUCTS-COMP/OP ADC $2,000.00E OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ X (Ea accident) ANY AUTO BODILY INJURY(Per person) S 250,00E ----' OWNED AUTOS ^SCHEDULED BODILY INJURY(Per accident) $500,00E ONLY AUTOS X HIRED AUTOS X NON-OWNED L58398 04/26/2018 04/26/2019 PROPERTY DAMAGE ONLY _AUTOS ONLY (Per accident) $100.00E $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ — EXCESS LIAB CLAIMS-MADE AGGREGATE S DED I I RETENTION S S - WORKERS COMPENSATION AND PER I OTHER EMPLOYERS'LIABILITY YM STATUTE ANY PROPRIETOR/PARTNER/ El N/A E.L.EACH ACCIDENT S EXECUTIVE OFFICER! MEMBER EXCLUDED? E.L DISEASE-EA EMPLOYEE $ Il yea dascrae Omer DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S $ $ S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES CERTIFICATE HOLDER CANCELLATION City of Oshkosh SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 215 Church St. DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY Oshkosh, WI 54901 PROVISIONS. AUTHORIZE EPRE N TIVE ti- -4 ©1988-2015 AeofintillWoRATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD CL-517(3-16)