Loading...
HomeMy WebLinkAboutMichels Civil 2-1-19 ACC,RE, CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 01/`18/2018 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 Minnesota, Inc. PHONE FAX c/o 26 Century Blvd. (A/C NOFxT) 877-945-7378 (A/O NO)• 888-467-2378 P. 0. Box 305191 E-MAILDD AREss certificates@willis.com Nashville, TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Greenwich Insurance Company 22322-001 INSURED INSURERS: National Fire and Marine Insurance Compan 20079-001 Michels Civil, A Division of Michels Corporation 817 Main Street INSURERC:XL Specialty Insurance Company 37885-901 Brownsville, WI 53006 INSURERD:XL Specialty Insurance Company 37885-001 INSURERE: Zurich American Insurance Company 16535-501 INSURER F: COVERAGES CERTIFICATE NUMBER:26049444 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 SUER POLICY NUMBER 'POLICY EFF POLICY EXP LIMITS I TR pJ D WVD (MM/DD/YYYY) (mM/OD/YYYY) A X COMMERCIALGENERALLIABILITY y CGD740955301 2/1/2018 2/1/2019 EEAApCCMHpp��OEECCCURRENCE $ 1,000,000 PREMISES(�a CLAIMS-MADE X OCCUR Eoacurence) $ 300,000 MED EXP(Any one person) $ PERSONAL&ADVINJURY $ 1,000,000 GEN'LAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE $ 2,000,000 POLICY X PRO JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y CAD740955401 2/1/2018 2/1/2019 EOa BINEDSINGLELIMIT $ 2,000,000 X ANY AUTO BODILY INJURY(Perperson) $ - OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) B UMBRELLA LIAR X OCCUR y 42-XSF-100139-05 2/1/2018 2/1/2019 EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED RETENTION$ $ C WORKERS COMPENSATION CWD740955101 2/1/2018 2/1/2019 X PER OTR- AND EMPLOYERS'LIABILITY STATUTE ER D ANY PROPRIETOR/PARTNER/EXECUTIVE N I N/A CWR740955201 2/1/2018 2/1/2019 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory.in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 lives,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 8 CPP 3547840-17 2/1/2018 2/1/2019 Installation Floater Per Occurrence 2,000,000 Temporary Storage Per Occurrence 2,000,000 Transit I Per Occurrence 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project Name/#/Description: Public Works Contract No. 17-07, South Park Basin Retrofit. Project Address/Location: South Park Basin Retrofit. Coverage for Contractual Liability is provided under General Liability policy. City of Oshkosh and its officers, council members, agents, employees and authorized volunteers are Additional Insureds with respect to the Gene l Liabilit and Auto Liability and the work performed CERTIFICATE HOLDER Y CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE . a 2 4 jj II THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Oshkosh Attn: City Clerk ' 215 Church Avenue CITY� �-RK`fi---- AUTHORIZED REPRESENTATIVE PO Box 1130 Oshkosh, WI 54903-1130 SC Coll:5169259 Tpl:2195675 Cert:26049444 ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD