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HomeMy WebLinkAboutGreat Lakes Roofing Corp 5-1-19 ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/21/2018 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). 'RODUCER CON(ALT HNI Risk Services of Wisconsin NAME: PO Box 510187 E-MAIL,Ext): 262-782-3940 FAX No): 262-782-4198 ADDRESS: certs(O7hni.com New Berlin WI 53151 INSURER(S)AFFORDING COVERAGE NAIC U INSURER A: The Continental Insurance Co.CNA(A:XV) NSURED Great Lakes Roofing Corp. INSURER B: Transportation Insurance Company CNA(A:XV) INSURER C: Valley Forge Insurance Company CNA(A:XV) INSURER o: Continental Casualty Company CNA(A:XV) W194 N11095 Kleinmann Drive INSURERE: Germantown WI 53022-3802 INSURER F: OVERAGES 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. 'tSR ADDL SUBR POLICY EFF POLICY EXP -TR TYPE OF INSURANCE INSR WVD POLICY_NUMBER (MMIDDIYYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY Y Y 2064532858 05/01/2018 05/01/2019 PREMISES(Ea orccu ence) $ 100,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 —1 POLICY X PROT LOC $ JEC COMBINED SINGLE LIMI I B AUTOMOBILE LIABILITY V 2064532875 05/01/201805/01/2019 (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED — SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERrY DAMAGE X HIRED AUTOS X AUTOS (Per accident) $ D x UMBRELLA LIAB X OCCUR 2064532889 05/01/201805/01/2019 EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION WC STATU-Y/N 264532892 05/01/201805/01/2019 X TORY LIMITS O TH- C AND EMPLOYERS'LIABILITYER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICE/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 f]FCCRIPTIf}N CIF CIPFRA7lC1NS halnw A Inland Marine 2064532858 05/01/201805/01/2019 Leased/Rented Aggregat 140,000 Physical Damage Leased Limit per item 25,000 )ESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) The certificate holder is included as additional insured on General Liability as required by written contract or agreement,with respect to work performed by the Named Insured. :ERTIFICATE HOLDER CANCELLATION City of Oshkosh SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: City Clerk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ty ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1130 215 Church Avenue AUTHORIZED REPRESENTATIVE Oshkosh WI 54903-1130 ©1988-2010 ACORD CORPORATION. All rights reserved.