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HomeMy WebLinkAboutDrucks Plumbing & Heating 9-1-19 Susan Lambert.WISC.AAI.AIS,ACSR.PWCAM FaxID:Johnson Insurance Date:8/23/2018 1:54:41 PM Paae:2 of 2 �..iN DRUCPLU-01 SLAMBERT F AC C,ME:)' DATE(MM/DD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 08/23/2018 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 .11AME: Johnson Insurance Northeast NE (A/�No,Ext): (800)776-7055 I FAX No):(877)254-8586 318 South Washington Street Green Bay,WI 54301 ^ ,infoeuLohnsonins.com INSURER(S)AFFORDING COVERAGE NAIC K.._._ INSURER A:West Bend Mutual Ins Co 15350 INSURED INSURER B:Accident Fund Insurance Company of America 10166 Drucks Plumbing& Heating Co Inc INSURER C 314 Appleton Street _INSURER 0: Menasha,WI 54952 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 I POLICY EFF POLICY EXP 1T3 IF; POLICY NUMBER '1141.WP.D1....(MWDPAYY.YL. LIMITS A X COMMERCIAL GENERAL UABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED 300,000 CLAIMS-MADE I X OCCUR 0941561 09/01/2018 09101/2019 PREMI$E.�,(Ed,cx:cucS MED EXP(Any_onelaerson1 S 10,000 PERSONAL&ADV INJURY S 1,000,000 »GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S H2'000,000 POLICY rX 1 PELT L._J LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: _ _..... �.._.._ »... »._......_....___._. _.»........ S A AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT S 1,000,000 X ANY AUTO I941561 09/01/2018 09/01/2019 BODILY INJURY(Per person) _S OWNED 1 SCHEDULED _AUTOS ONLY AUTOS BODILY INJURY(Per acciden)L S AUTOS ONLY AUTOSNO ONLY PROPERTY_ e ,L S .».. .., S A X UMBRELLA LIAB I X OCCUR EACH OCCURRENCE S 2,000,000 EXCESS LIAB • CLAIMS-MADE 1941561 0910112018 09/01/2019 AGGREGATE s 2,000,000 DED 7 RETENTIONS 0 S B WORKERS COMPENSATION X t PER OTH- AND EMPLOYERS'UABILITY Y/N -.------;?SAIL!..• --•••-- WCV 6171517 09/01/2018 09/01/2019 100,000 ANY PROPRIETOR/PARTNER/FYFCUTIVE E.L.EACH ACCIDENT S OFFCER/MEMBER EXCLUDED? [N] N/A 1 OO,000 (Mandatory In NH) »EL.DISEASE-EA EMPLOYEE S __,_•--„- If yes,describe under 500,000 DESCRIPTION OF OPERATIONS be,ow •• E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) 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 Y ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1130 Oshkosh,WI 54901-1130 AUTHORIZED REPRESENTATIVE k 1 c2‘0,A41,k, ino ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD