Loading...
HomeMy WebLinkAboutCapelle Brothers & Diedrich 1-1-19 CAPEBROOPC PDEANOVICH A COR J DATE IMM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 01/16/2018 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 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 Pamela Deanovich,CISR NAME: — Jackson Kahl Insurance Services,LLC 17 N Pioneer Road 1 N,Ed):(920)923-40201112 FAX No►:(866)218-6850 Fond Du Lac,WI 54935 ADDRIESS:pdeanovichtJacksonkahl.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:West Bend Mutual Insurance Co. 15350 INSURED INSURER B: Capelle Brothers&Diedrich,Inc. INSURERC: P.O.Box 1274 INSURER D: Fond du Lac,WI 54936-1274 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 NUMBER POLICY EFF POUCY EXP LIMITS LTR INSD WVD IMMIDD/YYYY1 IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X OCCUR 2282100 01/01/2018 01/01/2019 DMGEEOE RoNcTuErDre nce) $ 200,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG -$ 2,000,000 OTHER: S A AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) S X ANY AUTO 2282100 01/01/2018 01/01/2019 BODILY INJURY(Per person) $ OWNED EOS ONLY SCHEDULED SSWULNED BODILY INJURY(Per accident),S X AUTODS ONLY X AUOTOS ONLB (Peer accident4AMAGE A X UMBRELLA UAB X OCCUR EACH OCCURRENCE S 10,000,000 EXCESS LIAB CLAIMS-MADE 2282100 01/01/2018 01/01/2019 AGGREGATE $ 10,000,000 DED X RETENTIONS 0 S A WORKERS COMPENSATION X STATUTE X ERH AND EMPLOYERS'LIABILITY Y/N 0570764 01/01/2018 01/01/2019 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,descnbe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,AddItIonal Remarks Schedule,may be attached If more space Is required) The City of Oshkosh Consultants,architects,architect consultants,engineers,engineer consultants,contractors and subcontractors are as an additional insured on a primary and non-contributory basis with a waiver of subrogation under the General Liability per forms CG2010X(0704), CG2037(0704,CG2404 (0509),under Business Auto per form CA2048_0299 `j�12i�9/ED The umbrella policy includes the general liability,automobile liability and employer's liability in its underlying. Buil into et§ d s' otice of cancellation with 10 days for non-payment. LFEB 0 6 201$ CERTIFICATE HOLDER CANCELLATION ::1120NO—SC:.1-1.ERKOFFIC>�SHOULD ANY OF THE ABOVE DESCRICIES BE CANCELLED BEFORE The ko Of I54903- Attn:CI Clerk THE EXPIRATION DATE THEREOFTICE WILL BE DELIVERED IN y tY ACCORDANCE WITH THE POLICY PRO 215 Church Street I P.O.Box 1130 Oshkosh,WI 54903-1130 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD