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HomeMy WebLinkAboutMJ Electric 5.1.19 ACORI' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 5/1 2019 4/12/2018 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 LOCKTON COMPANIES CONTACT 3657 BRIARPARK DRIVE,SUITE 700 PHONE FAX HOUSTON TX 77042 RECEI` Li) No,Eat): (A/C,No) E-MAILE-M 866-260-3538 ADDRESS: INSURERISI AFFORDING COVERAGE NAIC N APR 1 0 201° INSURERA: Old Republic Insurance Company 24147 INSURED M.J.ELECTRIC,LLC INSURER B: ACE Property&Casualty Insurance Co 20699 1380395 A QUANTA SERVICES COMPANY • 200 W.FRANK PIPP DRIVE rOFPUE3LICWOi' INSURERD: INSURER IRON MOUNTAIN MI 49801 OsHKO'I-{ W ISCON� : INSURER E: INSURER F: COVERAGES MJSEROI CERTIFICATE NUMBER: 14491996 REVISION NUMBER: XXXXXXX 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY)IMM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y N MWZY 313093 5/1/2018 5/1/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE EOCCUR DAMAG PREM SES(Ea occTO ur RENTED $ 1,000,000 MED EXP(Any one person) $ Excluded PERSONAL&ADV INJURY $ 1,000.000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 _ POLICY X 1 JE Q LOC PRODUCTS-COMP/OP AGG $ 2,000,000 l OTHER $ A AUTOMOBILE LIABILITY Y N MWTB 313092 5/1/2018 5/1/2019 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO Ep BODILY INJURY(Per person) $ XXXXXXX X AOUTOS ONLY AUTOQQSULED BODILY INJURY(Per accident $ XXXXXXX _ X AUTOS ONLY X AUTOS ONLYY PROPERTY acciden DAMAGE $ XXXXXXX $ XXXXXXX I; X UMBRELLA LIAB X OCCUR Y N XOO G27972032 003 5/1/2018 5/1/2019 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000.000 _ DED RETENTION$ $ XXXXXXX A WORKERS COMPENSATION YIN N MWC31309400 5/1/2018 5/1/2019 X STATUTE OER AND EMPLOYERS'LIABILITY (� ANY ANYIPROPRIET ER EARTNER/EXECUTIVE t�l NIA E.L EACH ACCIDENT $ I,000,000 (Mandatory In NH) V E L DISEASE-EA EMPLOYEE $ I.000.000 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ I.000,000 — DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re: Annual Excavation/Work in Right-of-Way License/Permit. Additional Insured in favor of City of Oshkosh(on all policies except Workers' Comp/EL)where and to the extent required by written contract.30 days notice of cancellation is included on the policies. CERTIFICATE HOLDER CANCELLATION See Attachments SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 14491996 AUTHORIZED REPRESENTATIVE City of Oshkosh Attn:City Clerk 215 Church Avenue PO Box 1130 OshKosh WI 54903-1130 --4- ACORD 25(2016/03) ©1988-2015 ACORD CORPORATI .All rights reserved The ACORD name and logo are registered marks of ACORD