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HomeMy WebLinkAboutDane Construction 5-23-19 �-...IN DANECON-01 SZOROMSKI ACORO DATE(MMIDD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 07/03/2018 - 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). CONTACT PRODUCER NAME: Ansay&Associates,LLC.-OSH 430 N.Koeller Street AJC,No,Ext):(920)235-2764 FAX No):(920)235-2694 E-MAIL info ansa Oshkosh,WI 54902 ADDRESS: nfo@ansay.com _ INSURERISZAFFORDING COVERAGE NAIC 0 INSURER A:Owners INSURED Construction LLC INSURER B:Auto Owners y Insurance Company_ 18988 Dane _ Jns INSURER c:West Bend Mutual-WC POOL Dan 935 Linden Oaks Drive 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD )MM/DD/YYYYI IMMIDD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 61366343 05/23/2018 05/23/2019 DAMAGE TO RENTED 300,000 PREMISES(Ea occurrence) S MED EXP(Any one person) S 10'000 PERSONAL S ADV INJURY S 1,000,000 GENII_AGGREGATE OMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY P LOC PRODUCTS_COMP/OP AGG S 2,000,000 OTHER S COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILE LIABILITY (Ea accident) S_ X ANY AUTO 5036634300 05/23/2018 05/23/2019 BODILY INJURY(Per person) S OVVNED SCHEDULED AUTOSONLY AUTOS yyNNEE BODILY INJURY(Per accident) $ AUTOS ONLY S VVONL° (Per PROPERTY DAMAGE ♦$ — S B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 2,000,000 EXCESS LIAB CLAIMS-MADE 5036634301 05/23/2018 05/23/2019 AGGREGATE s 2,000,000 DED X RETENTIONS 10,000 S C WORKERS COMPENSATION PER X OTH- AND EMPLOYERS'LIABILITY __STATUTE ER . Y/N 1909869 01/18/2018 01/18/2019 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $- OFFICER/MEMBER EXCLUDED', N/A 500,000 (Mandatory m NH) E.L.DISEASE—EEA EMPLOYEE'S Ir yes describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES )ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Oshkosh and its officers,council members,agents,employees,and authorized volunteers are listed as an Additional Insured with resects to the general liability policy including products completed operations. 30 Day Notice of cancellation is also included. 4 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Clerk 215 Church Ave Oshkosh,WI 54901 AUTHORIZED� D REPRESENTATIVE TH ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD