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HomeMy WebLinkAboutGene Frederickson Trucking 10-1-19 AC Q® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 2/21/2019 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 NAME: Kristin Boevers Spectrum Insurance Group 303 Packerland Dr, Suite C lac N No,Exn:920-426-2431 (N,No):920-385-0855 Green Bay WI 54307 RECEIVLL) ADDRESS: kristin.boevers@spectruminsgroup.com INSURER(S)AFFORDING COVERAGE NAIC U g ?019 INSURERA:Sentry Insurance 24988 INSURED GENEF-1 • INSURER B GENE FREDERICKSON TRUCKING INC ' I L fil.l� WORKS GF INC OF WI, DMS LTD, COBBLE l INSURERC: 4450 FIELDCREST DR ,S4 Ho. NS1N , wtSCO INSURERD: KAUKAUNA WI 54130-4539 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:967450803 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. IN SR R TYPE OF INSURANCE ADDL SUBR INSD WVD, POLICY NUMBER (MM/DD!YYYY) IMM DD/YYYY) LIMITS LT A X COMMERCIAL GENERAL LIABILITY Y A0040209004 10/1/2018 10/1/2019 EACH OCCURRENCE $1,000,000 DAMAGE RENTED CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $500,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY X rjr- X LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER $ A AUTOMOBILE LIABILITY A0040209001 10/1/2018 10/1/2019 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) A X UMBRELLA LIAB X OCCUR A0040209006 10/1/2018 10/1/2019 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTIONS tn,nnn $ A WORKERS COMPENSATION A0040209005 10/1/2018 10/1/2019 X PER OTH- AND EMPLOYERS LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/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 $1,000,000 A Contractors Equipment A0040209003 10/1/2018 10/1/2019 Hired or Leased $700,000 II Deductible 1,000 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Oshkosh, and it officers, council memberd, agents,employees and authorized volunteers are included as additional Insured for general liability CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Oshkosh PO Box 1130 Oshkosh WI 54903 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD