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HomeMy WebLinkAboutProfessional Concrete Raising 6-1-19 i Cindv Hansen FaxID Ansav&Associates Date 6/152018 7:29:44 AM Paae:2 of 2 ___....-......, PROFCON-03 CHANSEN DATE(MM/DDNYYY) ,acoizo" CERTIFICATE OF LIABILITY INSURANCE �� i 06/15/2018 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 Cindy Hansen Ansay&Associates,LLC. MTW O (A/cC,No,Eat): (920) 370-4238 1 FAX No):(920)437-4179 4712 Expo Drive Manitowoc,WI 54220 12'%'6 cindy.hansen©ansay.com INSURER(S)AFFORDING COVERAGE.-_�_•_,-• NAIL N__••, INSURER A:Secura Insurance A Mutual Company 22543 INSURED INSURER B: Professional Concrete Raising Inc INSURER C:_•••_• _..--_•.,•,•_••_,•_- N 9656 Darboy Drive INSURER D: Appleton,WI 54915 INSURERE: ...__..._..»»___—.»»»» ._..»._..».................._...._»...... 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 ADDL®=' POLICY EFF POLICY EXP TYPE OF INSURANCE , , RI POLICY NUMBER 'LMM(DQvYyYL tt'DD/YYYYI LIMITS A X COMMERCIAL GENERAL UABILITY EACH OCCURRENCE S 1,000,000 _ •• TO RFa.ENTEDRGD »__ DAMAGE Ef] CLAIMS-MADE � X� OCCUR X C3269199 06/01/2018 06/01/2019 pREMISElK&urreI 3 100,000 _ MED EXP(Any p oneersonJ S 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 PRo- POLICY r^l JECT r-1 LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER_ _.--...-.....—s.._._..._._._ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 (ER.DS.W�P.JIE). X ANY AUTO X •3269200 06/01/2018 06101/2019 BODILY INJURY(Per person) S OWNED 1 SCHEDULED AU�T�O�S ONLY AUTOSS ,BODILY INJURY(Per acciden) S —AUTOS ONLY AUTOS ONLY _TPROPERTYer ttDAMAGE S 5 UMBRELLA LIAR ^ OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED 17 RETENTION$ _.. •• S . WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N ..STATUTE. .ER __...._ _..._ ANY PROP RIETOR/PARTNER/FYFCUTIVE E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? I ] N/A (Mandatory In NH) " E.L.DISEASE•EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below „•, E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CG2010 is attached to the general liability.CA2048 is attached to the auto liability CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Oshkosh&its officers council members,agents, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 ACCORDANCE WITH THE POLICY PROVISIONS. employees&Auth volunteers PO Box 1130 Oshkosh,WI 54903-1130 AUTHORIZED REPRESENTATIVE I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD