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HomeMy WebLinkAboutFox Excavating 12-4-19 FOXEXCAOPC RZIVKOVICH ACCPRD DATE(MM/OD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 7/24/2019 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 CONTACT Rebecca Zivkovich,CISR _ NAME,' Jackson Kahl Insurance Services,LLC PHONE 800 236-50101128 FAx 17 N Pioneer Road (NC,No,Eat):( ) (Iuc,Noi:(866)218-6850 Fond Du Lac,WI 54935 AMI DDRESS:rzlvkovich@jacksonkahl.com INSURER(S)AFFORDING COVERAGE NAIL i INSURER A:Frankenmuth Insurance 01398 INSURED INSURER B: Fox Excavating LLC INSURER C: N2346 Maloney Road INSURER D: Kaukauna,WI 54130 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR, ,INSD JAW IMM/DD/YYYYI (MWDD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE I Xl OCCUR 6609893 12/4/2018 12/4/2019 DRMGEOENccTuErrD ne) $ 500,000 MED EXP(Any one person) $ 5,000 _ PERSONAL&ADV INJURY $ 1,000,000 GENt AGGREGATE LIMITR APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY X I ECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: ERRORS AND OMIS $ 1,000,000 COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILE LIABILITY (Ea accident) X ANY AUTO 6609892 12/4/2018 12//4/2019 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS yy��p BODILY INJURY(Per accident)3 _ AUTOS ONLY AUTOS ONLY (Per PROPERTY DAMAGE $ A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 5,000,000 EXCESS LIAB CLAIMS-MADE 6609893 12/4/2018 12/4/2019 AGGREGATE S DED X RETENTIONS 10,000 Aggregate S 5,000,000 A WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 6609891 1214/2018 1214/2019 E.L EACH ACCIDENT $ 1,000,000 MFFICER/MEMBER EXCLUDED? N/A andatory In NH) E.L.DISEASE-EA EMPLOYEE$ _ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Errors&Omissions 6609893 12/4/2018 12/4/2019 Errors&Omissions 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) City of Oshkosh,and its officers,council members,agents,employees and authorized volunteers by form Form C 2001 Blanket Additional Insured Primary& Non-contributory and includes Products-Completed Operations form 07741. 30 Day Cancel Notice for City of Oshkosh by form 94114. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Oshkosh-Public Works-Engineering Division THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 g ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Ave,PO Box 1130 Oshkosh,WI 54901-4747 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD