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HomeMy WebLinkAboutJoe Denoble Sewer & Water 4-8-19 l.Gr( I IrII.H I C Lir LIMDILI I T IIVJUr(HIVI.0 I 06/05/2018 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 NAME:CONTACT DAVID ANDERSON ADEMINO&ASSOCIATES INC PHONE FAX DAVID ADEMINO lac,No,Extl:920-734-3110 (NC No): 920-734-6027 1001 TRUMAN P 0 BOX 99 E-MAIL DRESS: danderson@ademino.com KIMBERLY,WI 541 3 6-0 099 DAVID ANDERSON INSURER(S)AFFORDING COVERAGE NAIL X INSURER A:SELECTIVE INSURANCE 19259 INSURED JOE DENOBLE SEWER&WATER INSURER e:BURNS &WILCOX LTD CONSTRUCTION INC EHN TRUCKING LLC INSURER C: 774 W ADAM DR INSURER D: DE PERE,WI 54115 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. IN ADM.SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE IINSD WVD POLICY NUMBER L (MMIDD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00( CLAIMS-MADE X OCCUR X S 2270932 04/08/2018 04/08/2019 DAMAGE TO RENTED 500,00( PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,00( PERSONAL&ADV INJURY $ 1,000,00( GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,00( POLICY X jE X LOC PRODUCTS-COMP/OP AGG $ 3,000,00( OTHER' $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00( (Ea accident) A X I ANY AUTO X S 2270932 04/08/2018 04/08/2019 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,00( A EXCESS LAB CLAIMS-MADE S 2270932 04/08/2018 04/08/2019 AGGREGATE $ 10,000,00( DED X RETENTION$ 0 _$ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LABIUTY STATUTE ER Y/N A ANY PROPRIETOR/PARTNER/EXECUTIVE WC 9052137 04/08/2018 04/08/2019 E.L.EACH ACCIDENT $ 1,000,00( OFFICER/MEMBER EXCLUDED? N/A --- (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00( If yes,describe under 1,000,00( DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B EXCESS UMBRELLA APP146731214 04/25/2018 04/25/2019 LIABILITY 2,000,00( DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CITY OF OSHKOSH,AND ITS OFFICERS, COUNCIL MEMBERS, AGENTS, EMPLOYES AND AUTHORIZED VOLUNTEERS ARE AN ADDITIONAL INSURED WITH REGARD TO AUTOMOBILE LIABILITY (CA7809), AND FOR ONGOING &COMPLETED OPERATIONS WITH REGARD TO GENERAL LIABILITY(CG7988) CERTIFICATE HOLDER CANCELLATION OSCIT-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF OSHKOSH THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 215 CHURCH ST PO BOX 1130 AUTHORIZED REPRESENTATIVE OSHKOSH,WI 54901 a ��� � o/Y4• Qi»+.� - I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD