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HomeMy WebLinkAboutInterCon Construction 4-7-19 -----1 ,,o rl-fI MM'f/17rY,'.Y ACC:WC, CERTIFICATE OF LIABILITY INSURANCE 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 w certificate does not confer rights to the certificate holder in lieu of such endorsement(s). .c cu CONTACT 7 PRODUCER NAME: _ Aon Risk Services Central, Inc. PHONE (920) 437-7123 FAX (920) 431-6345 m Green Bay WI office (AJC.No.But): (A/C.No.): M 111 N. washington Street, Suite 300 E-MAIL o P. 0. Box 23004 ADDRESS: _ Green Bay WI 54305-3004 USA INSURERS)AFFORDING COVERAGE NAILS INSURED INSURERA: The Phoenix Insurance Company 25623 InterCon Construction, Inc INSURERB: The Travelers Indemnity Co. 25658 S512 State Road 19 & 113 Waunakee WI 53597-9530 USA INSURER C: Travelers Property Casualty Ins Co 36161 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570070695810 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MWDDIYYYYI1 1IMMIDDM/YY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y VTN-CO-6]773090-PHX-1$ 04/07/2018 04/07/2019 EACHOCCURRENCE S1,000,000 General Liability DAMAGE TO RENTED $300,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) MED EXP(Any one person) S10,000 PERSONALS.ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERALAGGREGATE S2,000,000 m POLICY n ECT LOC PRODUCTS-COMP/OPAGG S2,000,000 0 0 OTHER. 0 B AUTOMOBILE LIABILITY VTK-CAP-63 7 7 3108-IND-18 04/07/2018 04/07/2019 COMBINED SINGLE LIMIT $1,000,000 `n Auto Liability (Ea accident) X ANY AUTO BODILY INJURY(Per person) 0 Z OWNED SCHEDULED BODILY INJURY(Per accident) m AUTOS ONLY AUTOS PROPERTY DAMAGE X HIRED AUTOS X NON-OWNED O (Per accident) '�ONLY AUTOS ONLY t m C X UMBRELLA LIAB X OCCUR VTSM]-CUP-6777311A-TIL-18 04/07/2018 04/07/2019 EACHOCCURRENCE $24,000,000 0 Umbrella Liability AGGREGATE $24,000,000 EXCESS LIAB CLAIMS-MADE DED RETENTION 'C WORKERSCOMPENSATIONAND VTRJ-UB-6J773041-18 04/07/2018 04/07/2019 X STATUTEEOTH EMPLOYERS'LWBILITY ER YIN Workers Compensation ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S1,000,000 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 $1,000,000— AM 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 INCLUDED AS ADDITIONAL i INSURED INCLUDING COMPLETED OPERATIONS PER FORM CGD246 WHERE REQUIRED BY WRITTEN CONTRACT SUBJECT TO POLICY TERMS AND CONDITIONS r- tm CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE C EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF OSHKOSH AUTHORIZED REPRESENTATIVE C- 215 CHURCH ST OSHKOSH WI 54901 USA elr .. �� K e� ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD