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HomeMy WebLinkAboutFiber Optic Management 1-1-19 ..rmiN I UKNK-4 UP ID:G13 '` b.,— CERTIFICATE OF LIABILITY INSURANCE DATE 12/29/2017 ) �-� 12/29/2017 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 616-949-0490 CONTACT PAUL S BUITEN NAME: BUITEN & ASSOCIATES, LLC PHONE 616 949 0490 1 FAX 616-949-0433 5738 FOREMOST DRIVE,SE (A/C,No,Eat): (A/C,No): GRAND RAPIDS, MI 49546 E-MAIL aul.buiten buiteninsurance.com PAUL S BUITEN ADDREDRESS:p INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:TRAVELERS INS CO 25615 INSURED FIBER OPTIC MANAGEMENT LLC INSURER B:ACCIDENT FUND INS CO OF AMER 10166 DBA TURNKEY NETWORK SOLUTIONS ALTERRA AMERICA INSURANCE CO 7020 SOUTHBELT DR SE INSURERC: CALEDONIA, M149316 INSURER D:HANOVER INSURANCE COMPANY 22292 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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRINSD WVD IMM/DD/YYYYI (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DT-0005G866698 01/01/2018 01/01/2019 DGORoNccTErDe nce) $ 300,000 X XCU COVERAGE MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER EMP BEN $ 1,000,000 COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILE LIABILITY (Ea accident) $ X ANY AUTO DT 8105G866698 01/01/2018 01/01/2019 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSRp ONLY _ AUTOS W BODILY INJURY(Per accident) $ X HIRED ONLY X AUOTOS ONLYY (Per accident)DAMAGE $ X HIRED CAR HC PHY DAM $ 75,000 A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE DT CUP5G866698 01/01/2018 01/01/2019 AGGREGATE $ 10,000,000 DED X RETENTION$ 10000 $ B WORKERS COMPENSATION X ER P OTH- AND EMPLOYERS'LIABILITY STATUTE ER WCV6087646 12/31/2017 12/31/2018 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE _E.L.EACH ACCIDENT $ MFFICER/MEMBER EXCLUDED? N/A INCL:GAIN IL MI MO WI 1,000,000 andatory m NH) _E.L.DISEASE-EA EMPLOYEE $ _ It yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A RAILROAD CGD316 DT CO05G866698 01/01/2018 01/01/2019 AGG/OCCUR 1000/2000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RECEIVED IVED ADDITIONAL INSURED ON ALL LIABILITY POLICIES ARISING OUT OF PROJECT WORK ,- REl — SHALL BE THE CITY OF OSHKOSH AND ITS OFFICERS,COUNCIL MEMBERS,AGENTS,EMPLOYEES AND AUTHORIZED VOLUNTEERS. 30 DAY NOTICE OF CANCELLATION PER THE JAN 1 6 2018 CONDITIONS AND PROVISIONS. 10 DAYS FOR NON-PAYMENT OF PREMIUM. CM Y CLERKS OFFICE CERTIFICATE HOLDER CANCELLATION OSHKOSH 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 AVENUE AUTHORIZED REPRESENTATIVE PO BOX 1130 PAUL S BUITEN OSHKOSH,WI 54903 I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD