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HomeMy WebLinkAboutL & H Gyr Excavating 8-1-19 �..41 L&HGEX1 OP ID: K3 .4CORif) DATE(MM/DDIYYYY) �� CERTIFICATE OF LIABILITY INSURANCE 01/24/2019 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 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 NAME: Jon Templin,CISR,CRIS Hausmann-Johnson Insurance Inc RECEIVED PHONE FAX 700 Regent St.,PO Box 259408 (A/c,No,Ext):608-257-3795 (A/c,No): 608-257 4324 Madison,WI 53725-9408 E-MAIL ADDRESS: Jon Templin,CISR,CRIS FEB 05 2019 INSURER(S)AFFORDINGCOVERAGE NAIC# INSURER A:Sentry Insurance 24988 INSURED L& H Gyr Excavating, In&EPT(ii PUBLIC WORKS INSURER B:Travelers Casualty&Surety 19038 629 Van Dyne Rd OSHKOSH, WISCONSIN INSURER C: Fond du Lac,WI 54937-1448 - INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 2019 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 INSDA ISU BR WVD POLICY NUMBER MIPOLICY EFF POLICY EXP LIMITS (MDD/YYYY) (MMIDDIYYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X] OCCUR X A0059430004 08/01/2018 08/01/2019 DAMAGE TO RENTED PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 5,000 _PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY X JEC LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO A0059430001 08/01/2018 08/01/2019 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS _ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 11,000,000 A EXCESS LIAB CLAIMS-MADE A0059430007 08/01/2018 08/01/2019 AGGREGATE $ 11,000,000 DED RETENTION$ 0 $ WORKERS COMPENSATION X PER OTH- i AND EMPLOYERS'LIABILITY STATUTE ER Y A 'ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A A0059430006 08/01/2018 08/01/2019 EL_EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500 000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) When required in written contract The City of Oshkosh,and its officers, council members, agents,employees and authorized volunteers shall be listed as additional insureds with regard to general liabliity.A 30 Day Notice of Cancellation applies,with the exception of workers comp. CERTIFICATE HOLDER CANCELLATION CITYOSH 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. Office of City Clerk 215 Church Ave AUTHORIZED REPRESENTATIVE PO Box 1130 Oshkosh,WI 54903-1130 ©1988-2014 ACORD CORPORATION. All rights reserved.