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HomeMy WebLinkAboutGabes Construction Company 7-1-19 A ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 6/21/2018 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 CONTACT Christine Miramontes NAME: R&R Insurance Services Inc RECEIVE PHONE (262)574-7000 —1(rc.No):(262)574-7080 Arc No.EAR) 1581 E Racine Avenue 'HAIL christine.miramontesOrrina.com ADDRPO Box 1610 INSURER(S)AFFORDING COVERAGE NM 8 Waukesha WI 53187-1610 FEB -6 2 ' INSURER A:Phoenix Insurance Company 25623 INSURED INSURERS Travelers Property Casualty Ins Co 25674 Gabes Construction Company Inc )lII ( INSURER C:Travelers Indemnity Company of CT 25682 itiflf,r , ,i,. ;. r-, 4804 N 40th St INSURER D:Continental Insurance Company 35289 PO Box 385 INSURER E: Sheboygan WI 53082-0385 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1862183093 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 EFF POLICY EXP LIMITS LTR ,JNSDW YYY VO POLICY NUMBER (MMIDDIY JMMIFD�YYYJ X COMMERCIAL GENERAL LIABILITY ' EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE I X I OCCUR DAMAGE TO RENTED 300,000 ISES(Ea occurrence) $ C0-9K367898 7/1/2018 7/1/2019 MED EXP(Any one person) $ 10,000 OCG D6 04 (AI/PNC) PERSONAL 8 ADV INJURY $ 1,000,000 GEM_AGGREGATE LIMIT APPLIES PER: #CG D6 04 (AI/Opa) GENERAL AGGREGATE $ 2,000,000 POLICY X JEC T LOC MCG D3 16 (WOS) PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER _ $ ,�� AUTOMOBILE UY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ B —ALL OWNED —SCHEDULED _ AUTOS AUTOS 810-9R286207 7/1/2013 7/1/2019 BODILY INJURY(Per accident) $ , NON-OWNED SCA T3 53 (AI/WOS) PROPERTY DAMAGE $ X X HIRED AUTOS _ AUTOS (Per accident RCA T4 74 (PNC) $ ,B X UMBRELLAUAB X OCCUR CUP-91C389055 (Lead S1OM) 7/1/2018 7/1/2019 EACH OCCURRENCE $ 20,000,000* D x EXCESSUAB CLAIMS-MADE SUM 06 37 (AI/PNC) AGGREGATE $ 20,000,000* DED X RETENTION$ 10,000, , #UN 04 88 (WOS) $ WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY YIN STATUTE OTH- ER ANY PROPRIETOR/PARTNER/EXECUTIVE N f A EL EACH ACCIDENT $ 2,000,000 C (Mandatory In NH EMBER EXCLUDED? I N UB-8K449046 7/1/2018 7/1/2019 ( ory ) E.L.DISEASE•EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1,000,000 B Installation Floater 660-1D65560A 7/1/2018 7/1/2019 My One Jobsite 1,000,000 Leaned/Rented Equipment 660-1D65560A 7/1/2018 7/1/2019 Any One Item 500,000 DESCRIPTION OF OPERATIONS I 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 are Additional Insured for General Liability (includes ongoing & completed operations) and Auto Liability (per forms above) on a primary and non-contributory basis as required by contract. 30-Day Notice of Cancellation applies in favor of the certificate holder; except for non-payment of premium. 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 Department of Public Works ACCORDANCE WITH THE POLICY PROVISIONS. & City Clerks Office 215 Church Avenue AUTHORIZED REPRESENTATIVE PO Box 1130 II Oshkosh, WI 54903-1130 Thomas Scheider/DM586 �� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS02512n1dn11