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HomeMy WebLinkAboutHoltger Bros 7-1-19 �—.m1 ae DATE(MMIDD/YYYY) ,d.�a CERTIFICATE OF LIABILITY INSURANCE 01/10/2019 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). c PRODUCER CONTACT NAME: — Aon Risk Services Central, Inc. PHONE (920) 437-7123 FAX (920) 431-6345 d Green Bay wI Office (A/C.No.Ext): (A/C.No.): LI 111 N. washington Street, suite 300 E-MAIL 0 P. O. Box 23004 1. ADDRESS: I Green Bay WI 54305-3004 USA �'119 INSURER(S)AFFORDING COVERAGE NAIC# 4 INSURED JAB c1 11 J WSURERA: The Phoenix Insurance Company 25623 Holtoer Bros., Inc. Iv (, w C'' INSURERS: The Travelers Indemnity Co. 25658 950 W Main Ave )1;LIC De Pere WI 54115 USA D1.p1 OF VI" �)JtSCO' INsuRERC: The Travelers Indemnity Co of CT 25682 O`t,t� CI INSURER D: Travelers Property Cas Co of America 25674 JJ[[''A INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570074754122 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. Limits shown are as requested INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY11 ((MMIDDIYYYY) LIMITS A X COMMERCIALGENERALLIABILITY V DT-Co-31166769-PHX-18 07/O1/2018 07/01/201 EACHOCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR General Liability DAMAGETORENILU $300,000 PREMISES(Ea occurrence( MED EXP(Any one person) 810,000 PERSONAL 8ADV INJURY $1,000,000 N GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE 82,000,000 N POLICY riJEa ( J LOC PRODUCTS-COMP/OPAGG $2,000,000 0 OTHER. o B AUTOMOBILE LIABILITY Y DT-8 10-3 3 16 54 84-IND-18 07/01/2018 07/01/2019 COMBINED SINGLE LIMIT $1,000,000 N Automobile (Ea accident) X ANY AUTO BODILY INJURY(Per person) 0 Z OWNED SCHEDULED BODILY INJURY(Per accident) 0 AUTOS ONLY AUTOS PROPERTY DAMAGE to X HIRED AUTOS x NON-OWNED U ONLY .AUTOS ONLY (Per accident) E N 0 X UMBRELLALIAB X OCCUR CUP-33193250-18-26 07/01/2018 07/01/2019 EACHOCCURRENCE S10,000,000 0 UMBRELLA AGGREGATE 810,000,000 EXCESS LIAR CLAIMS-MADE DED X RETENTION$10,000 C WORKERS COMPENSATIONAND UB-3317180A-18-26-G 07/01/2018 07/01/2019 x PER OTH- EMPLOYERS'LIABILITY YIN Workers Compensation STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N NI A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes.describe under - —- - - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S1,000,000— NM DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) a- 1 ADDITIONAL INSURED ON A PRIMARY & NON-CONTRIBUTORY BASIS ON THE GENERAL LIABILITY AND AUTO CITY OF OSHKOSH, AND ITS OFFICERS, COUNCIL MEMBERS, AGENTS, EMPLOYEES AND AUTHORIZED VOLUNTEERS AS THEIR INTEREST MAY APPEAR AS RESPECTS THE WORK BEING DONE PER `i BLANKET ADDITIONAL INSURED ENDORSEMENT AS REQUIRED BY WRITTEN CONTRACT. ENDORSED POLICIES WILL INCLUDE A 30 DAY NOTICE OF s CANCELLATION/NONRENEWAL FOR ANY REASON OTHER THAN NONPAYMENT OF PREMIUM, PROVIDED TO THOSE PARTIES INDICATED IN THE WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE C EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE OATH THE POLICY PROVISIONS. ate~ CITY OF OSHKOSH AUTHORIZED REPRESENTATIVE M� 215 CHURCH AVENUE po Box 1130 ele OSHKOSH WI 54903 USA .Q4 Me /� ft 4we c p� �a�y �rQ�c J 6 = ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD