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HomeMy WebLinkAboutHickey Roofing 4-23-19 HICKE-2 OP ID: RG ACORN CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/VYYV) 04/02/2018 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 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 920-233-4000 ' CONTACT Brian McClone McClone-Oshkosh PHONE FAX 505 North Westfield Street (NC,No,Ext):920-233-4000 I(A/C,No):920-233-2728 Oshkosh,WI 54902-4105 ADDRESS:brian.mcclone@mcclone.com Brian McClone INSURER(S)AFFORDING COVERAGE NAIL M INSURER A:SECURA Insurance,A Mutual Co 22543 INSURED Hickey Roofing,Inc. INSURER B:Middlesex Insurance Co 23434 Mr.William Hickey 1427 Broad Street INSURER C: Oshkosh,WI 54901 INSURER D: 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS VTR INSD-bp/D IMM/DD/YYYY1 (YM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X CP3235984 0.$/23/2018 04/23/2019 PRAEM sEnE aEoccu ante) $ 100,000 MED EXP(Any one person) $ 5,000 x Agg Per Project PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea a cjdentl X ANY AUTO _ A3235985 04/23/2018 04/23/2019 BODILY INJURY(Per person) $ - OWNED SCHEDULED _ AUTOS ONLY _ AUTOS SSBODILY INJURY(Per accident) $ _ AUTOS ONLY _ NON-OWNEDUUOS ONLY PROPERTY DAMAGE (Per accident) S. $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE ' CU3235986 04/23/2018 04/23/2019 AGGREGATE $ 1,000,000 DED X RETENTION$ 10000 S B WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 89_278450-01 04123/2018 04/23I2019 EL.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED/ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes.describe under 500,000 DESCRIPTION OF OPERATIONS below J L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/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 with respects to General Liability Coverage per form ILE 1037 11/05. A 30 Day Notice of Cancellation applies in favor of the City of Oshkosh. CERTIFICATE HOLDER CANCELLATION OSHKOSI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF OSHKOSH ACCORDANCE WITH THE POLICY PROVISIONS. 215 CHURCH AVENUE P.O. BOX 1130 AUTHORIZED REPRESENTATIVE OSHKOSH,WI 54902-1130 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD