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HomeMy WebLinkAboutMain Concrete 1-1-19 MAINC-1 OP ID: CMW '4c'oRo CERTIFICATE OF LIABILITY INSURANCE DATE(MDD/1Y1'1� oar27/ 2o1 a 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 920-734-3110 FialecT DAVID VANBOOGARD ADEMINO & ASSOCIATES INC PHONE 920-734-3110 FAX 920-734-6027 DAVID ADEMINO INCE.�q,�No,Ext): I(A/C,No): Mss.dvanboogard@ademino.com TRUMAN P 0 BOX 99 SS:dvanboogard@ademino.com KIMBERLY, WI 541 3 6-0099 DAVID VANBOOGARD INSURER(S)AFFORDING COVERAGE NAIC i INSURER A:WEST BEND MUTUAL INS 15350 INSURED MAIN CONCRETE INC INSURER B: PO BOX 186 DALE,WI 54931-0186 INSURERC: INSURER D: INSURER E: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MMIDOM'YY) (MMIDDIYYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X A369710 D 01/01/2018 01/01/2019 PREMISES(E(EGE TO a urencel $ 200,000 _ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEM_AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,000 POLICY X JECT X LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER $ COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO X A369710 01/01/2018 01/01/2019 BODILY INJURY(Per person) $ X OWNED SCHEDULED AUTOS��� ONLY NAM E BODILYO INJURYp (Per accident) $ X HAUTOS ONLY X AUTOS 049 (Derr accderd) GE _ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 EXCESSLIAB CLAIMS-MADE A369710 01/01/2018 01/01/2019 AGGREGATE $ 3,000,000 DED X RETENTION $ 0 $ A WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE ER OTH- ANY PROPRIETOR/PARTNERiEXECUTIVE Y IN A369754 01/01/2018 01/01/2019 E.L.EACH ACCIDENT $ 100,000 QFFICERJMEMBER EXCLUDED? N I A (Mandatory In NH) E L DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) - CITY OF OSHKOSH,AND ITS OFFICERS,COUNCIL MEMEBERS,AGENTS,EMPLOYEES,AND RECEIV^. AUTHORIZED VOLUNTEERS ARE ADDITIONAL INSURED • MAY 04 2018 j CITY CLEi2€. CERTIFICATE HOLDER CANCELLATION OSCIT-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF OSHKOSH THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 215 CHURCH ST OSHKOSH,WI 54901 AUTHORIZED REPRESENTATIVE a ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD