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Home My WebLink AboutJ Harvey Contracting 5-1-19 JHARVEY-01 MWOLF ,d►CORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 05/11/2018 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 CONTACT NAME: The Diedrich Agency HO 303 High Avenue (AICNNo,Eat):(920)232-4090 I FAX (NC,No):(920)748-5044 Oshkosh,WI 54902 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC X INSURER A:Acuity 14184 INSURED INSURER B: J Harvey Contracting LLC INSURER C: 2220 Springbrook Road INSURERD: Omro,WI 54963 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 SUER POLICY NUMBER POLICY EFF POLICY EXP/Y LIMITS LTR INSD WVD (MM/DDIYYYYI,IMMIDDYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR Z44745 05/01/2018 05/01/2019 DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&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 VOLUNTARY PROPE $ 2,500 COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILE LIABILITY _(Ea accident) X ANY AUTO Z44745 05/01/2018 05/01/2019 BODILY INJURY(Per person) $ O_ AUTOS ONLY _ SCHEDULED SWULED BODILYO INJURYp (Per accident) $ AUTOS ONLY _ AUTOS ONLY (Per acudenq AMAGE $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 1,000,000 EXCESS LIAB CLAIMS-MADE Z44745 05/01/2018 05/01/2019 AGGREGATE $ DED X RETENTIONS 0 $ A WORKERS COMPENSATION X STATUTE ERPER H AND EMPLOYERS'LIABILITY 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N Z44745 05/01/2018 05/01/2019 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED'? Y N/A 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Jarrod Harvey is excluded under the workers compensation policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn City Clerks Office PO Box 1130 Oshkosh,WI 54903 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD