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HomeMy WebLinkAboutLee Kienast Excavating 3-15-19 A D® CERTIFICATE OF LIABILITY INSURANCE DATE(MMDD/YVVY) 03/19/2018 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 Thomas Wagner NAME: Oshkosh Insurance Agency,Inc (A/CONIo,Eel): (920)426-5520 (AX No) (920)426-5252 310 W Irving Ave E-MAIL tom©oshkoshinsuranceservices.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC/ Oshkosh WI 54901 INSURER A: Pekin Insurance-Farmers Ins 24228 INSURED INSURER B Lee Kienast Excavating,LLC. INSURER C: 765 N Washburn St, INSURER D: INSURER E: Oshkosh WI 54904 INSURERF: COVERAGES CERTIFICATE NUMBER: CL1831902603 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. IPOLICY EFF POLICY EXP NSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMIDD/YYYY MM DONYYV LIMITS LTR INSD WVD ( ) ( l X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 50,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 A CL0156692 03/15/2018 03/15/2019 PERSONAL BADV INJURY $ 1,000,000 GENIIAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X LOC PRO- 2,000,000 JECT PRODUCTS-COMPIOPAGG $ OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ 1,000,000 A X OWNED SCHEDULED P674685 03/15/2018 03/15/2019 BODILY INJURY(Per accident) $ 1,000,000 AUTOS ONLY AUTOS XHIRED —J NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) X UMBRELLA LIAB _ OCCUR EACH OCCURRENCE S 1,000,000 A EXCESS LIAB CLAIMS-MADE 00CU31647 03/15/2018 03/15/2019 AGGREGATE $ X DED RETENTION$ 10,000 S WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'LIABILITY Y/N 500,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE N/A OOWC95620 03/15/2018 03/15/2019 E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 Il yes,descnbe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RECEIVE Policies are Primry/non-contributary with blanket additional insureds and Waiver of Subrogation. Completed/on going operatations in future are also provided by and included in policies. The Blanket coverage replaces the need to list each additional insured and waive of subrogation. MAR 19 201$ ciry 1 0 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. AUTHORIZED REPRESENTATIVE '_l_` V� .w♦ 1- ®1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD