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HomeMy WebLinkAboutNortheast Asphalt 3-1-19 „..._-----.40 DATE(MM/DD/YYYY) A o® CERTIFICATE OF LIABILITY INSURANCE 06/06/2018 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 w certificate does not confer rights to the certificate holder in lieu of such endorsement(s). m PRODUCER CONTACT SI NAME: AOn Risk Services Central, Inc. PHONE FAX Green Bay WI Office (AC.No.Est): (920) 437-7123 (�No.): (920) 431-6345 m O 111 N. Washington Street, Suite 300 E-MAIL o P. 0. Box 23004 ADDRESS: _ Green Bay WI 54305-3004 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: The Travelers Indemnity Co. 25658 Northeast Asphalt, Inc. INSURER B: Travelers Property Cas Co of America 25674 c/o Kylie Sippel PO Box 1632 INSURER C: Navigators Insurance Co 42307 Waukesha WI 53187 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570071551118 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. Limits shown are as requested INSR1 ADDL SUBR POUCY EFF POUCY EXP LTR TYPE OF INSURANCE INSD END POUCY NUMBER (MMIDDM'YYI1 IMMIDDIYYYY) UNITS A X COMMERCIAL GENERALLIABIUTY VTC2K-00-7211B454-IND-18 03/01/2018 03/01/2019 EACHOCCURRENCE 51,000,000 General Liability DAMAGE TO RENTED $300,000 CLAIMS-MADE n OCCUR PREMISES(Ea occurrence) MED EXP(Any one person) S5,000 PERSONAL&ADV INJURY $1,000,000 ro GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S2,000,000 POLICY n JE 0. n LOC PRODUCTS-COMP/OPAGG $2,000,000 n O OTHER: bi- O A AUTOMOBILE LIABILITY VTC2K-CAP-3049P020-IND-18 03/01/2018 03/01/2019 COMBINED SINGLE LIMIT $2,000,000 N Automobile (Ea accident) ,• X ANY AUTO BODILY INJURY(Per person) Z OWNED SCHEDULED BODILY INJURY(Per accident) a) AUTOS ONLY _AUTOS PROPERTY DAMAGE U X HIRED AUTOS x NON-OWNED ONLY ^AUTOS ONLY (Per accident) 'C m C X UMBRELLALIAB X OCCUR NY18EXC131205IV 03/01/2018 03/01/2019 EACH OCCURRENCE $10,000,000 U umbrella AGGREGATE $10,000,000 EXCESS LIAR CLAIMS-MADE DED RETENTION B WORKERS COMPENSATION AND VTRJ-UB-66976998-18 03/01/2018 03/01/2019 x PER STATUTE OTH- EMPLOYERS'LIABILnY YIN workers Compensation - WI ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 IF yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000- , = 2 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER, ITS EMPLOYEES AND OFFICERS ARE ADDITIONAL INSURED ON THE COMMERCIAL GENERAL LIABILITY POLICY PER THE TRAVELERS ADDITIONAL INSURED ENDORSEMENT #CG D2 46 08 05, IF REQUIRED BY CONTRACT, AND TO THE EXTENT CAUSED BY THE NEGLIGENT ACTS OR OMISSIONS OF THE NAMED INSURED. 502 .aiij CERTIFICATE HOLDER CANCELLATION =_ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF OSHKOSH AUTHORIZED REPRESENTATIVE Y 215 CHURCH AVENUE PO BOX 1130 x /� Or OSHKOSH WI 54903 USA � i!/ W O Sf'es W 11. ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD