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HomeMy WebLinkAboutMerten Plumbing & Heating 6-1-19 i.--4,4 MERTE-1 OP ID:JV ,d►coRo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 4.----- 05/23/2018 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 920-734-3110 CONTACT DAVID VAN BOOGARD ADEMINO&ASSOCIATES INC PHONE FAx DAVID ADEMINO (A/C,No,Ext):920-734-3110 FAX No):920-734$027 1001 TRUMAN P 0 BOX 99 E-MAIL dvanboogard@ademino.com KIMBERLY,WI 54136-0099 ADDRESS: DAVID VAN BOOGARD INSURER(S)AFFORDING COVERAGE NAIC li INSURER A:AUTO-OWNERS INSURANCE 18988 INSURED MERTEN PLUMBING&HEATING INC INSURER B 1087 COZY LN OSHKOSH,WI 54901 INSURER C: 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 VNTH 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 1 LIMITS LTR INSD WVO (MM/DD/YYYYI IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 61372617 06/01/2018 06/01/2019 DAMAGE SOE R EoNcuErD nce) $ 300,000 MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY X JECT X LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: S A AUTOMOBILE LIABILITY (Ea accident SINGLE LIMIT S 1,000,000 ANY AUTO 5037261700 06/01/2018 06/01/2019 BODILY INJURY(Per person) $ OWNED SCHEDULEDO BODILY INJURY(Per accident) $ AUTOSEp ONLY AUTOS BODILYq p X AUTOS ONLY AUUTOS ONLY IPerr a dent)AMAGE S $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS S A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y I N 61138622 06/01/2018 06/01/2019 ` 100,000 ANY FFICER//MIETOR EARTNER E .L ECUTIVE N!A E .EACH ACCIDENT $ (Mandatory n N ) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below , E.L.DISEASE-POLICY LIMIT S 1 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) -� '� AYE Alit \ .____ \ ( 'CLERK._ 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 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD