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HomeMy WebLinkAboutMi-Tech Services 2-1-19 A COROCERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 12/27/2m017 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). 4UTHORIZED 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 NO EXT) 877-945-7378 (A/C No) 888-467-2378 P. O. Box 305191 E-MAIL annREss certificates@willis.com Nashville, TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIC 8 INSURER A: Greenwich Insurance Company 22322-001 INSURED Mi-Tech Services, Inc. INSURER B:_National Fire and Marine Insurance Compare 20079-001 1700 Industrial Drive INSURERC:XL Specialty Insurance Company 37885-901 Green Bay, WI 54302 INSURER D:XL Specialty Insurance Company 37885-001 INSURER E: AIG Specialty Insurance Company 26883-001 INSURER F: COVERAGES CERTIFICATE NUMBER:26024925 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 ADDL SUBR POLICY EFF POLICY EXP L t: TYPE OF INSURANCE , D yyyp POLICY NUMBER (jaM/pI)YYYV) (MM/pp/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y CGD740955301 2/1/2018 2/1/2019 EACHOCCURRENCEEpApMMp��EEppp 1$ 1,000,000 CLAIMS-MADE X OCCUR PREMISES(taEoN2urence) $ 300,000 MED EXP(Any one person) $ PERSONAL&ADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- POLICY X JECT LOC PRODUCTS•COMP/OP AGG $ 2,000,000 i OTHER: $ A AUTOMOBILE LIABILITY Y 'CAD740955401 2/1/2018 2/1/2019 WEOaIggDSINGLELIMIT $ 2,000,000 X ANY AUTO BODILY INJURY(Perperson) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ UMBRELLALIAB X OCCUR Y 42-XSF-100139-05 2/1/2018 2/1/2019 EACHOCCURRENCE $ 10,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED RETENTION$ $ (,+ WORKERS COMPENSATION CWD740955101 2/1/2018 2/1/2019 X STATl1PER OTH- TE ER_ AND EMPLOYERS'LIABILITY D ANY PROPRIETOR/PARTNER/EXECUTIVEYNN 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 $ 1,0 0 0,0 0 0 II yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,0 0 0,0 0 0 E Contractors CPO 8197229 2/1/2016 2/1/2019 $10,000,000 Each Loss Pollution DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re: All Work Performed Under Written Contract or Agreement. Additional Insured on General Liability, Auto & Excess and Waiver of Subrogation on General Liability & Work Comp: Q3 Contracting Inc. ; each of their partners, parents, affiliates & officers, directors, employees & agents R '.CElvED CERTIFICATE HOLDER it \ JAN 0 9 2018 CANCELLATION • _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE �' ' ; THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITE'ELFItti -.__. ACCORDANCE WITH THE POLICY PROVISIONS. City of Oshkosh 'S OFFICE Attn: City Clerk AUTHORIZED REPRESENTATIVE P.O. Box 1130 215 Church Street Oshkosh, WI 54903-1130 SC ` Col1:5160852 Tp1:2195890 Cert:26024925 ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD