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HomeMy WebLinkAboutNovak Excavating 10-1-19 ____.--....,1 NOVAEXCOPC RZIVKOVICH A4CC30R1:3 CERTIFICATE OF LIABILITY INSURANCE DATE /DD/YYYYy �� 10/23/2018 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 CONTACT Rebecca Zivkovich Jackson Kahl Insurance Services,LLC 1081A W Fond du Lac St (A/CC,,"N,Ext):(800)236-5010 1128 FAX No):(866)218-6850 Ripon,WI 54971 E-MAIL URIEss:rivkovich@jacksonkahl.com INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:Frankenmuth Insurance 01398 INSURED INSURER B: Novak Excavating Inc INSURER C: Mr.Jeff Novak PO Box 389,525 Aspen Street INSURER D: Ripon,WI 54971 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 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMMIDD/YYYYI IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 6607723 10/01/2018 10/01/2019 DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ a accclidentSINGLE LIMIT $ 1,000,000 A AUTOMOBILE LIABILITY E X ANY AUTO 6607722 10/01/2018 10/01/2019 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED ONLY NON-OWNED AON-O WN ONLY PROPERTY DAMAGE AUTO (Per accident) $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE 6607723 10/01/2018 10/01/2019 AGGREGATE $ DED X RETENTION$ 10,000 $ A WORKERS COMPENSATION X I STATUTE PER I I ERH AND EMPLOYERS'LIABILITY Y/N 6607721 10/01/2018 10/01/2019 100,000 ANY OFFICER/MEMBEROPRIETO /PARTNER/E ECUTIVE N1 /A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE,$ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) RECElED OCT252018 cry��tItie ,aFfr` CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn:Emily Karl P.O.Box 1130 Oshkosh,WI 54902 AUTHORIZED REPRESENTATIVE 1 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights rec l� The ACORD name and logo are registered marks of ACORD �,