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HomeMy WebLinkAboutKinas Excavating 5-1-19 A`cwc, CERTIFICATE OF LIABILITY INSURANCE DATE IMMM ois) 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 Elizabeth A.Bille Nolan Insurance Agency, LLC NAME: - 112 E.Main Street talc°,ao.Ertl: (920)346-2241 FAX No): (920)346-5600 PO Box 238 E-MAIL Ibille@nolanins.com ADDRESS: Brandon,WI 539190238 INSURER(S)AFFORDING COVERAGE NAICI REC Ili I\. INSURER WEST BEND MUTUAL INS CO 15350 INSURED Kinas Excavating,Inc. INSURER B: N6205 Lawson Drive MAR 13 �� INSURERC: — -- Green Lake,WI 54941 J INSURER D: _ DEPT OF PUBLIC WORKS INSURE: OSHKOSH, WISCONSIN INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: _ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEE'J 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. INSRP � TYPE OF INSURANCE ADDL INVD POLICY NUMBER IMMIJC ) I POUCYOY) / LIMITS A Y COMMERCIAL GENERAL LIABILITY 0956044 05/01/2018 05/01/2019 _EACH OCCURRENCE $ 1,000,000 �/, DAMAGE TO RENTED CLAIMS-MADE V OCCUR PREMISES(Ea occurrence) $ 300,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY 0956044 05/01/2018 05/01/2019 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) 7 A• NY AUTO BODILY INJURY(Per person) $ O• WNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS H• IRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ A J U• MBRELLA LIAB OCCUR 0956044 05/01/2018 05/01/2019 EACH OCCURRENCE $ 6,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 6,000,000 DED RETENTION$ $ A WORKERS COMPENSATION 0956045 05/01/2018 05/01/2019 viPER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE M E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 I DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if rnore space is required) City of Oshkosh,and its officers,council members,agents,employees and authorized volunteers are additioanl insured on a primary and non-contributory basis on the general liability and auto liability.Cancellation or non-renewal 30 day prior written notice will be given to City of Oshkosh. CERTIFICATE HOLDER CANCELLATION Email:ttaylor@ci.oshkosh.wi.us 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 Oshkosh,WI 54901 AUTHORIZED REPRESENTATIVE EQ3 C.Ithfo &, ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD