Loading...
HomeMy WebLinkAboutAugust Winter & Sons 10-1-19 Page 1 of 1 DATE IMMIDYYYY) AWRL DICERTIFICATE OF LIABILITY INSURANCE O1/22/2019 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 ICOME:NTACT NA Willis Towers Watson Midwest, Inc. fka Willis of Minnesota, Inc. PHONE 1-877-945-7378 FAX 1-888-467-2378 c/o 26 Century Blvd INC.No.Ertl: INC,No): EMAIL certificates@xillis.cem P.O. Box 305191 ADDRESS: Nashville, TN 372305191 USA ( ,' INSURER(S)AFFORDING COVERAGE NAICI (� INSURERA: phoenix Insurance Company 25623 INSURED N 8 2j)\ INSURERS: Travelers Indemnity Company of CT 25682 E. August Winter Sons, Inc. `n P 0 Box 1896 .1�` -� )�S INSURERC: Travelers Indemnity Company 25658 Appleton, WI 549121896 1 'I '�( '' INSURERD: Charter Oak Fire Insurance Company 25615 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W9959421 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. NOTWTHSTANDING 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 SUBRV POLICY NUMBER POLICY EFF POLICY EXVY LIMITS (MMIDD/YYYY) fMMIDD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR PRSRENTED PREEMIMI ESES((Ea occurrence) $ 300,000 A X Contractual Liab. MED EXP(Any one person) $ 10,000 Y DT-CO-9K511354-PHX-18 10/01/2018 10/01/2019 PERSONALBADVINJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY X PRO- LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ S OWNED SCHEDULED Y DT-810-323D2093-TIA-18 10/01/2018 10/01/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ C X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 20,000,000 EXCESSUAB CLAIMS-MADE CUP-5J80755A-18-26 10/01/2018 10/01/2019 AGGREGATE $ 20,000,000 DED X RETENTIONS 10,000 $ WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY B ANYPROPRIETOR/PARTNERAEXECUTIVE Y/N EL.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED" No N IA UB-8L35972A-18 10/01/2018 10/01/2019 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Workers' Compensation and UB-OL000336-18-26-G 10/01/2018 10/01/2019 EL Each Accident $100,000 Employers Liability � EL Disease-Policy Lmt$500,000 WC - Per Statute EL Disease-Each Empl $100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Originally Issued: 1-2019; City of Oshkosh shall be included as Additional Insureds to the Commercial General Liability and Auto Policy per attached endorsements for acts caused by AWS in the performance of their work to which the written contract requiring insurance applies. 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. Attn: City Clerk 215 Church Avenue AUTHORIZED REPRESENTATIVE PO Box 1130 Oshkosh, WI 54903 UJ�' (f ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID, 17434516 BATCH 1036018 COMMERCIAL GENERAL LIABILITY POLICY NUMBER:CO-9K511354-PHX-18 GENERAL PURPOSE ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSIIRED - (Section II) is amended to include any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Coverage Part, but: a) Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the insurance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance". This endorsement shall not increase the limits of insurance described in Section III - Limits Of Insurance. b) The insurance provided to the additional insured does not apply to "bodily injury", "property damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services, including: i. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and ii. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional insured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products-completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that occurs before the end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage or the end of the policy period, whichever is earlier CG T8 08 Page 1 COMMERCIAL GENERAL LIABILITY POLICY NUMBER:Co-9K511354-PHx-18 GENERAL PURPOSE ENDORSEMENT 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to other insurance available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that other insurance. But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under such other insurance. 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, such notice should include: i. How, when and where the "occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. b) If a claim is made or "suit" is brought against the additional insured, the additional insured must: i. Immediately record the specifics of the claim or "suit" and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. d) The additional insured must tender the defense and indemnity of any claim or "suit' to any provider of other insurance which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insurance provided to the additional insured by this endorsement is primary to other insurance available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. - DEFINITIONS: "Written contract requiring insurance° means that part of any written contract or agreement under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused by an offense committed: a. After the execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. CG T8 08 Page 2