HomeMy WebLinkAboutDowling Construction 1-23-19 Monday, January 22, 2018 08:35 AMit
Andrew Ballard Insurance 920 233 8944 1
p,0
CORD
� CERTIFICATE OF LIABILITY INSURANCE DATE(MMroD YYY
YJ
01/22/2018
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 en 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 ouch endorsement(s).
PRODUCER CONTACT Andrew T. Ballard
NAME'
Andrew T Ballard (A/C. Ertl: 920-233-4902 (AC Not:
1091 South Washburn Street &MARESS aballard(c�ruralins.corn
Oshkosh,WI 54904 INSURER(S)AFFORDING COVERAGE NAIL it
INSURER A 1 Rural Mutual Insurance Company
INSURED INSURER B:
Dowling Construction Inc. INSURER C 1
3596 Steams Dr. INSURER D 1
Oshkosh,WI 54904 INSURER E:
INSURER F 1
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 AWL SUBS POLICY EFF I POLICY EXP LIMITS
LTR wan wvo POLICY NUMBER (MM(DDIYYYYI (MM/OD/YYYYI
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS MADE X OCCUR PREMISES(ER axc ence) $
MED EXP(Any ores person) $ 6,000
A BOP9116908 01/23/2018 01/23/2019 PERSONAL&ACV INJURY s 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000
7 POLICY T n LOC PRODUCTS-COMPlOPAGO $ 2,000,000
OTHER $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s 1,000,000
(ES accident)
ANY AUTO BODILY INJURY(Pet person) $
A OLROS ONLY X SCHEDULED BAP2239993 01/23/2018 01/23/2019 BODILY INJURY(Per nc,-Idsnl) $
HIRED NON-OWNED PROPERTY DAMAGE s 50,000
AUTOS ONLY _ AUTOS ONLY (Per accident)
$
X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,000
EXCESS LIAB CLAIMS MADE BOP9118908 01/23/2018 01/23/2019 AGGREGATE $
DED RETENT ION$ $
WORKERS COMPENSATION X STATUTE CTH-
ER
AND EMPLOYERS'LIABILITY
A ANY PR OPR lET OR/PASE'c TNEf/EXECUTIVE v� NIA WRKG080187 01/23/2018 01/23/2019 EL EACH ACCIDENT $ 100,000
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH) E L DISEASE-EA EMPLOYEE $ 100,000
If yakTIbe Ilmlgr E.L DISEASE•POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS below
YytuDESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional R.mark•SDI,\dots,may be attaclred if more■prow I■required)
'I I2it'!'�It•,JAN 22
trrh cso
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY Or THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Oshkosh ACCORDANCE WITH THE POLICY PROVISIONS.
215 Church Ave
PO Box 1130 AUTHORIZED REPRESENTATIVE
Andrew T Ballard
Oshkosh,WI 54903-1130
I
®1988.2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD