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HomeMy WebLinkAboutRoger Bowers Construction 4-1-19 ORO® DATE(MM/DD/YYYY) AC CERTIFICATE OF LIABILITY INSURANCE 2/21/2019 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 CONTACT Mary McLennan Spectrum Insurance Group GB PHONE FAX 303 Packerland Dr.,Ste C (A/c.No.Est):920-884-2850 (A/C,No):920-884-2851 Green Bay WI 54307 E-MAIL mary.mclennan©spectruminsgroup.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Sentry Insurance 21180 INSURED ROGER-3 INSURER B Roger Bowers Construction, Inc MAK — ` CU ly P.O. Box 346 INSURERC: Kaukauna WI 54130 DEPT 01- PUBLIC WORKS INSURERD: OSHKOSH, WISCONSIN INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:880072318 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 SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER (MMIDDIYYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y A0078232004 4/1/2018 4/1/2019 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED _ CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $500,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY X jE j LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY A0078232001 4/1/2018 4/1/2019 COMBINEDSINGLELIMIT $1,000,000 (Ea aceidenq X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) A X UMBRELLA LIAR X OCCUR A0078232006 4/1/2018 4/1/2019 EACH OCCURRENCE $3,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 DED X RETENTION$in non $ A WORKERS COMPENSATION A0078232005 4/1/2018 4/1/2019 X STATUTE ERH AND EMPLOYERS'LIABILITY --- ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? N/A(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 A Leased or Rented A0078232003 4/1/2018 4/1/2019 Limit 100,000 Contractors Deductible 500 Equipment DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Oshkosh,its officers,council members,agents,employees,and authorized volunteers are listed as Additional Insureds per the polciy forms,conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Oshkosh PO Box 1130 Oshkosh WI 54902 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD