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HomeMy WebLinkAboutAll Star Cutting & Coring 9-16-19 • R ALLSTAR-02 SMOHAN ACORO DATE(MM/DD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 03/04/2019 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 NAME CT Sandra R. Mohan,CIC, PWCAM Johnson Insurance Northeast IL L L k EL PH(A/O No,Ext):(920)445-7451 FAX(A/C,Nol:(877)254-8586 318 South Washington Street E-MAIL Green Bay,WI 54301 E-MAIL s:smohan©johnsonfinancialgroup.com INSURER(S)AFFORDING COVERAGE NAIL N INSURER A:Integrity Insurance Company 14303 MAR 1 9 2019 INSURED ,.,t 1,1 ()1' 1'llU1' WOtthS INSURER B: ALL STAR Cutting&Coring, LLC',1 ()till• \\ ISCONSIN INSURERC: 140 Allegiance Ct INSURERD: Appleton,WI 54913 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 ADDLISUBR POLICY EFF POLICY EXP I LTR TYPE OF INSURANCE INSD WVD POUCY NUMBER (MM/DD/YYYY) (MM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X CPP2719474 09/16/2018 09/16/2019 PREMISES(TEa oRElccurrencel $ 100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 2,000,000 POLICY X JE f LOC PRODUCTS•COMP/OP AGG $ 2,000,000 OTHER' $ A AUTOMOBILE LIABILITYC Ea aBINEDcctSINGLE LIMIT $ 1,000,000 X ANY AUTO CA 2719475 09/16/2018 09/16/2019 BODILY INJURY(Per person) $ OWNED - SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ AUE N pWN PROPERTY DAMAGE TOS ONLY _ AUTOS ONLY (Per accident) $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE 1CUP2719477 09/16/2018 09/16/2019 AGGREGATE $ 2,000,000 DED X RETENTION$ 0 Prod/Completed $ 2,000,000 A WORKERS COMPENSATION X STATUTE X ERH AND EMPLOYERS'LIABILITY Y/N WCP2719476 09/16/2018 09/16/2019 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $ (Mandatory in NH7 EXCLUDED? 500,000 E.L.DISEASE-EA EMPLOYEE $ I(yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Oshkosh and its officers,council members,agents employees and authorized volunteers are additional insureds per policy forms,conditions and exclusions. 30 day notice of cancellation has been endorsed. 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 PO Box 1130 Oshkosh,WI 54901-4747 AUTHORIZED REPRESENTATIVE ticbtrutelczY I — ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD