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HomeMy WebLinkAboutLueck's Home Improvement 8-1-19 �, LUECHOM-01 BWE AFRO- CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDIYYYY) 6/14/2019 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 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).e7 PRODUCER License#100290819 I_N2MEACT Bonnie Weiss Sheboygan,WI Hub International Midwest Limited PHONE 11 AX No)c 2124 Kohler Memorial Drive (A/C,No,Ext): Suite 300 E MAILESS:bonnie.weiss@hubinternational.com ADDR Sheboygan,WI 53081 INSURER(S)AFFORDING COVERAGE NAIL S INSURER A:Hastings Mutual Insurance Company 14176 INSURED INSURER B:American Interstate Insurance Company 31895 Lueck's Home Improvement Inc INSURER C:Lloyd's of London — - 15792 706 S Main Street INSURER D: —.. Oshkosh,WI 54902 INSURERE: - INSURER F: COVERAGES CERTIFICATE NUMBER: 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. - INTR ADDL SUER POLICY EFF POLICY EXP I LIMITS TYPE OF INSURANCE MD yyyp, POLICY NUMBER MWDD YYYYI (MM!DD!YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X CPP9750913 8/1/2018 8/1/2019 pREM19E8(EaEoowErrence) $ 500,000 MED EXP(Any one person) $ 5'000 — PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 2,000,000 lPOLICY I Xi j.e& I x I LOC PRODUCTS-COMP/OP AGO $ $ OTHER: CEO eBINED SINGLE LIMIT $ 1,000,000 A AUTOMOBILE LIABILITY X ANY AUTO ACV9750915 8/1/2018 8/1/2019 BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per awldent S_ - AURTEOS ONLY _ AUTOS BODILY (Per X AUTOS ONLY X AUTOS ONLY (Per acddenti —$--- I $ A X UMBRELLA LIAB I X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE IULC9750917 8/1/2018 8/1/2019 AGGREGATE S 5,000,000 I DED X RETENTION$ 0 - $ B WORKERS COMPENSATION I X PPERTUTE ERR 'AND EMPLOYERS'LIABILITY Y/N AVWCW12621732018 8/1/2018 8/1/2019 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N N/A(Mandatory in NH) El.DGRgASE-EA EMPLOYES S 1,000,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below C Pollution ded$2,500 SPEC0404 9/20/2018 9/20/2019 Per Claim 1,000,000 A Equipment Lease/rent CPP9750913 8/1/2018 8/1/2019 Limit 200,000 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is re9uired) V.Right-of-Way Obstruction/Right-of-Way Annual Excavation/Right-of-Way single Site Excavation/Work in Right-of-Way City of Oshkosh,its officers,council members,agents,employees&authorized volunteers are recognized as Additional Insureds as regards General Liability per form CON6063 1/18&Auto Liability per Form CA2048 10/13. CERTIFICATE HOLDER CANCELLATION 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. Attn:City Clerk 215 Church Ave. Oshkosh,WI 54903-1130 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD