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HomeMy WebLinkAboutDave Rabe Trucking & Excavating 7-1-19 ACORO0 DATE(MM/DD/YYYY) AC� CERTIFICATE OF LIABILITY INSURANCE 1/29/2019 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 NAME: Sarah Sell The Insurance Center PHONE FAX 920 Association Drive (Arc.No.Exty 800-944-1367 Xt 51137 (A/C,Not:920-734-8920 E-MAppleton WI 54914 ADDRESS: ssell©ticinsurance.com INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:Hastings Mutual 14176 INSURED INSURER B: Dave Rabe Trucking&Excavating Inc P O Box 3521 INSURER C: _ Oshkosh WI 54903 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1718315443 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. IFF POUCY EXP NSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER (MNWD/YYYYI (MINDD/YYYY) LIMITS LTR WSD WVD A X COMMERCIAL GENERAL LIABILITY CPP9960766 7/1/2018 7/1/2019 EACH OCCURRENCE $1,000,000 DAMAGE TO CLAIMS-MADE I X OCCUR PREMISES(EaENTED occurrence) $100,000 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 X JECOT- X LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: S A AUTOMOBILE UABIUTY ACV9960767 7/1/2018 7/1/2019 COMBINED SINGLE LIMIT 51,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) S - OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS xy HIRED X NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY (Per accident) S A X UMBRELLAUAB X OCCUR ULC9962235 7/1/2018 7/1/2019 EACH OCCURRENCE $1,000,000 - EXCESS LIAB CLAIMS-MADE AGGREGATE DED I RETENTION$ $ A WORKERS COMPENSATION WC 9960768 7/1/2018 7/1/2019 X AND EMPLOYERS'LIABILITY Y/N STATUTE OTH- ER ANYPROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $100,000 OFFICER/MEMBEREXCLUDED? (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 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Our agency has,upon your request,issued this certificate based on the information you provided. If you provided a contract,we reviewed only the insurance requirements portion of the contract. In performing this review,our Agency is not providing legal advice or a legal opinion concerning any portion of the contract. In addition,our Agency is not undertaking to identify all potential liabilities that may arise under this contract.This review is provided for your information,and should not be relied upon by third parties.Upon your authorization,we will make the necessary changes in your insurance program. Right of Way License City of Oshkosh.and its officers,council members,agents,employee and authorized volunteers are additional insureds on the general liability policy per forms PD0412&PD0413.Coverage is on a primary and non-contributory basis. For reasons other than non-payment of premium or insured's request,30 days'notice will be provided to the certificate holder in the event that the issuing company cancels the general liability,auto or workers compensation policies before the expiration date of the policies. 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. Attn: City Clerk 215 Church Ave PO Box 1130 AUTHORIZED REPRESENTATIVE Oshkosh WI 54903-1130 q`' ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD