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HomeMy WebLinkAboutBerndt Excavating 1-1-19 'AC�® GATE(MM/DDM'W) ��. CERTIFICATE OF LIABILITY INSURANCE 01/02/2018 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 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 JIM MITCHELL NAME: MITCHELL INSURANCE AGENCY PHONE Ext): 920-233-0272 FAX No): 920-233-2712 ANC.No.1924 S.WASHBURN ST E-MAIL ADDRESS: OSHKOSH,WI 54904 INSURER(S)AFFORDING COVERAGE NAIC A INSURER A: WILSON MUTUAL INSURANCE COMPANY INSURED INSURER B BERNDT EXCAVATING INSURER c: 1264 COUNTY RD FF INSURER D: OSHKOSH,WI 54904 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 EFF POLICY EXPW LIMITS LTR IN SD WVD POLICY NUMBER IMM/DD/YYI (MMJDD(YYYYI COMMERCIAL GENERAL UABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED CLAIMS-MADE X1 OCCUR PREMISESOoccurrence)(Ea $ 50,000 MED EXP(My one person) $ 5,000 A 3200908690 01/01/2018 01/01/2019 PERSONAL EADVINJURY a 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 - POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) S A ALL OWNED SCHEDULED 3200908690 01/01/2018 01/01/2019 BODILY!NJURY(Per accident) S AUTOS AUTOS - NON-OWNED PROPERTY DAMAGE S HIRED AUTOS - AUTOS (Per accident) UMBRELLA LIAB _ OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTIONSPER S WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE ERH A ANY PROPRIETOR/PARTNER/EXECUTIVE Y!N NfA 3200908690 01/01/2018 01/01/2019 E.L.EACH ACCIDENT $ 100,000 (Mandatory In N )R EXCLUDED? E.L.DISEASE-EA EMPLOYEE S 100,000 (Mandatory In NH) u yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHI ,Additional Rsm*ks Schedule,may be attached It mom space Is required) JAN 0 2 BD „ J; NKr CITY CLs 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 ST AUTHORIZED REPRESENTATIVE OSHKOSH,WI 54901 �v ©1988-201 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are gistered marks of ACORD