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HomeMy WebLinkAboutDelrar 4-1-19f ACR o® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 3/28/2018 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 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 Dawn Baker NAME: R&R Insurance services Inc (A/C.PHONE FAX NO.Est): 262-338-7879 (AFC,No):262-338-7879 2021 S 18th Avenue Suite 202 E-MAIL ADDRESS:Dawn.Baker@rrins.com PO Box 914 INSURER(S)AFFORDING COVERAGE NAIC H West Bend WI 53095-0914 INsuRERA:Acuity A Mutual Ins Co 14184 _ INSURED INSURER B: Delrar Inc INSURERC: N136 Two Mile Rd INSURERD: INSURER E: Appleton WI 54914 INSURER F: COVERAGES CERTIFICATE NUMBER:CL183880722 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 EFF POLICY EXP LIMITS ,LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) IMM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AMAGERENTE A CLAIMS-MADE X OCCUR Z93723 4/1/2018 4/1/2019 PR M SESO(Ea occurrence) $ 250,000 X Blanket AI - Ongoing Ops CH7191 MED EXP(Any one person) $ 10,000 X Blanket AI Comp Ops PNC CB7242 PERSONAL S ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY PRO LOC PRODUCTS-COMP/OPAGG $ 3,000,000 JECT OTHER Voluntary Property Damage $ 5,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED Z93723 4/1/2018 4/1/2019 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS x PROPERTY DAMAGE $ NON (per accident) AUTOS-OWNED CA7214 Uninsured motorist BI splil limit $ 1,000,000 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAR CLAIMS-MADE C07098 AGGREGATE $ 5,000,000 DED RETENTIONS None 293723 4/1/2018 4/1/2019 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBE N/A A (Mandatory lnNH)EXCLUDED7 N Z93723 4/1/2016 4/1/2019 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/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) L EC. ,1`E_- APR8 CITY CLERK'S OFFICE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church St Oshkosh, WI 54901-4747 AUTHORIZED REPRESENTATIVE S VanLaanen/DB530 _ _ L_ 1:„...-";.:....-__ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)