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HomeMy WebLinkAboutCorevac 1-1-19 A ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)12/19/2017 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 Linda Famularo NAME: R&R Insurance Services Inc (A/C.No. (262)953-7227 IA/C.No):(262)953-1325 1581 E Racine Avenue E-MAIL ADDRESS:linda.famularo@rrins.com PO Box 1610 INSURER(S)AFFORDING COVERAGE NAIC# Waukesha WI 53187-1610 INSURER A:The Phoenix Insurance Company 25623 INSURED INSURER B: Corevac LLC INSURER C: W2385 County Road A South INSURERD: INSURER E: Oostburg WI 53070 INSURER F: COVERAGES CERTIFICATE NUMBER:18/19 Certs 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 r ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS ITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 300,000 CO9D297717 1/1/2018 1/1/2019 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY IX I JECT PRO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Employee Benefits $ 1,000,000 AUTOMOBILE UABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 8109D297717 1/1/2018 1/1/2019 BODILY INJURY(Per accident) $ AUTOS AUTOS — NON OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per accident) - Undennsured motorist BI $ 1,000,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 7,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 7,000,000 DED X RETENTION$ 10,000 CUP9D297717 1/1/2018 1/1/2019 $ WORKERS COMPENSATION X 1 PER STATUTE I 1 OERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N N/A A (Mandatory In NH) EUa9D29771 1/1/2018 1/1/2019 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under I DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Installation Floater CO90297717 1/1/2018 1/1/2019 $100.000 Limit$1000 Ded Leased/Rented Equipment $200,000 Per Item Limit DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) . \ S--- J pp. rr CERTIFICATE HOLDER CANCELLATION ekarl@ci.oshkosh.wi.us SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 Church Avenue ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1130 Oshkosh, WI 54903 AUTHORIZED REPRESENTATIVE William Katzfey/C220 -,-_- G ---~ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS02517014n11