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HomeMy WebLinkAboutJones Sign Company 8-1-19 Page 1 of 2 DATE(MMtDD/YYYY) A`R o CERTIFICATE OF LIABILITY INSURANCE OS/O1/zD18 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 Willis Towers Watson Certificate Center NAME: Willis of Minnesota, Inc. c/o 26 Century Blvd ((�PpH/�ONrE�, g 1-877-945-7378 (per No 1-888-467-2378 P.O. Box 305191 EADDM p 88: certificatesewillis.com Nashville, TN 372305191 USA INSURER(8)AFFORDINGCOVERAGE NAIC# INSURER A: Liberty Insurance Corporation 42404 - INSURED INSURER 8: Liberty Mutual Fire Insurance Company 23035 Jones Sign Company, Inc. _--- -- - Attn: Bonnie Vann INSURERC: _ 1711 Scheuring Road INSURERD: De Pere, WI 54115 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:W7110647 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. ILT R ATYPE OF INSURANCE i,o WVD_ POUCY NUMBER POLICY EFF POLICY EXP LIMITS LTR ,1MM/DDlYYYY1JMM!DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _$ 1,000,000 CLAIMS-MADE X I OCCUR PREMISES� T occurrence) $ 1,000,000 A MED EXP(Any one person) $ 10,000 Y TB7-191-467682-048 08/01/2018 08/01/2019 PERSONAL&ADVINJURY i 1,000,000 GEM AGGREGATE UMITAPPUES PER: GENERALAGGREGATE 8 2,000,000 ' POUCY X JiTta LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Fa accident) X ANY AUTO BODILY INJURY(Per person) $ D — OWNED SCHEDULED Y AS2-Z91-467682-038 08/01/2018 08/01/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED '-`— NON-OWNED 1 PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) 1r UMBRELLA UAB OCCUR EACH OCCURRENCE $ — EXCESS UAB CLAIMS-MADE AGGREGATE S 1 DEC RETENTIONS — S WORKERS COMPENSATION X PER OTH- STATUTE ER AND EMPLOYERS'LIABILITY B ANYPROPRIETOR/PARTNER/EXECUTIVE Y N E.L.EACH ACCIDENT S 1,000,000_ OfFICER/MEMBEREXCLUDED? No N/A WC2-Z91-467682-028 08/01/2018 08/01/2019 1,000,000 (Mandatory In NH) E.L.DISEASE-_EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UNIT $ B Workers Compensation (CA,CO,MN) WC2-Z91-467682-068 00/01/2018 08/01/2019 Z.L. Each Accident '$1,000,000 6 Employers Liability Z.L. Disease-EA Empl $1,000,000 Per Statute Z.L. Disease-Pol Lmt $1,000,000 DESCRIPTION OF OPERATIONS,LOCATIONS,VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) SEE ATTACHED 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 Attn: City Clerk 215 Church Avenue AUTHORIZED REPRESENTATIVE Po Box 1130 �J Oshkosh, WI 549031130 %- Yo-t~ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 16518777 BATCH, 810021 2 of 2 390