Loading...
HomeMy WebLinkAboutKS Energy Services 10-30-19 Page 1 of 2 DATE(MM/DD/YYYY) ACR pr CERTIFICATE OF LIABILITY INSURANCE 10/26/2018 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: Willis of New York, Inc. PHONE 1-877-945-7378 FAX 1-888-467-2378 c/o 26 Century Blvd I EC.E/17 (A/C.No. .�: (A/C,No): P.O. Box 305191 L 1' ADDRESS: certificates@willis.com Nashville, TN 372305191 USA INSURER(S)AFFORDINGCOVERAGE NAIC# ' B 1 9 2919 INSURERA: Greenwich Insurance Company 22322 INSURED ())_/, INSURERS: XL Insurance America Inc 24554 KS Energy Services, LLC I O/ /�( 19705 W. Lincoln Avenue O I I I\() /R/,/C (,VQ INSURER C: XL Specialty Insurance Company 37885 New Berlin, WI 53146 USA /'. ( /(''� ��`i S,k.s INSURER D: Chubb Indemnity Insurance Company 12777 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W8666684 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 SUBR POLICY EFF POLICY EXP MD LTR INSD D POLICY NUMBER (MM/DD(YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LUIBILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 300,000 A X incl XCU S Contractual MED EXP(My one person) $ 5,000 X Liability i RR Liability Y CGE7409782 SIR 10/30/2018 10/30/2019 PERSONAL BADVINJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY X JEC7 X LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED CAD 740935304 10/30/2018 10/30/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) _ $ B X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE US00076832L118A 10/30/2018 10/30/2019 AGGREGATE $ 10,000,000 DED RETENTIONS $ WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE ERA YIN B ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBEREXCLUDED7 NIA CWD 740935104 10/30/2018 10/30/2019 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ C Workers Compensation CWR 740935004 10/30/2018 10/30/2019 E.L. Each Accident $1,000,000 and Employer'a Liability E.L. Disease Each Em1$1,000,000 Per Statute 1E.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 AUTHORIZED REPRESENTATIVE P.O. Box 1130 ��4 Oshkosh, WI 54902 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID 16990918 BATCH: 929926