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HomeMy WebLinkAboutAG Excavating 4-13-19 �..matio AGEXC-1 OP ID:WF ACORN DATE(MM/DDIYYYY) �� CERTIFICATE OF LIABILITY INSURANCE 04/02/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATES 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(:), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poiicy(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 920-336-1312 cNADMVACT Debra J.Verstegen Dickenshied Cravillion ; PHONE 920-336-1312 FAX 920-339-2422 Insurance Services,Inc. (A/C,No,Ext): I(AIC,No): PO Box 5550 EAbl ss; De Pere,WI 54115-5550 Debra J.Verstegen MISURERtS)AFFORDING COVERAGE NAIC* _-- INSURER A:Erie Insurance Group INSURED AG Excavating INSURER B: Al Gossen 1336 Russett Ct INSURER C: Green Bay,WI 54313 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POLICIES of INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TH€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 POUCY EFF POUCY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER lyy,DCUYYYI /MWppryyyn UMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR Y Q40-1350637 04/13/2018 04/13/2019 PRREMISES(Ea occa encel $ 1,000,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE UMIT APPLES PER: GENERAL AGGREGATE 3 3,000,000 • POLICY X JECT ri LOC PRODUCTS-COMPIOPAGG $ 3,000,000 OTHER; - S A AUTOMOBILE LABILITY (Ea accNEEDD SINGLE LIMIT $ 1,000,000 X ANY AUTO Q04-1340048 04/13/2018 04/13/2019 BODILY INJURY(Per person) $ OWNED X SCHEDULED AUTOS�E� ONLY AUUTNOSyy E BODILYO INJURYD (Per accident) $ X AUTOS ONLY X AU7o1 ONLDY (Perr as dent]SAGE $ $ A X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS UAB CLAIMS-MADE 028-1370234 04/13/2018 04/13/2018 AGGREGATE $ 2,000,000 DED X RETENTIONS 0 ,3 A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N X STATUTE TH ANY PROPRIETOR/PARTNER/EXECUTIVE 488-1300640 04/13/2018 04/13/2019 500,000 FICER/MEMBER EXCLUDED? N I A EL EACH ACCIDENT andatory In NH) EL.DISEASE-EA EMPLOYEE__ $ 500,000 If yes.describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S A Inland Marine 440-1350637 04/13/2018 04/13/2019 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is included as Additional Insured regarding the General Liability. CERTIFICATE HOLDER CANCELLATION CITYO01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Ave PO Box 1130 Oshkosh,WI 54903 AUTHORIZED REPRESENTATIVE Debra J.Verstegen ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD