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HomeMy WebLinkAboutPTS Contractors 7-10-19 ___—"", PTSCO-1 OP ID: MH ,nc�RL CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 44.------- 02/05/2019 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 920-725-3232 CONTACT NAME: Mallory Scott McGlone PHONE 920-725-3232 FAX )920-725-3233 150 Main Street,Ste 300 lac,No,Ext): (ac,No Menasha,WI 54952-0389 ADDRESS:mallory.scott@mcclone.com Troy Carlson FEB -7 2019 INSURER(5)AFFORDING COVERAGE NAIC# INSURER A:Sentry Insurance a Mutual Co 24988 INSURED PTS Contractors Inc u i.i' l or PUBLIC WORKS INSURER B:Middlesex Insurance Co 23434 4075 Eaton Road OSHKOSII, WISCONSIN Green Bay,WI 54311 INSURER C: INSURER D: 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 ADOL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRINSO WVO IMM/DD/YYYY1 IMM/DD/YYYY1 B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X A0083395005 07/10/2018 07/10/2019 DAMAE TO RENED PREMISES Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY X 70 X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER. $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea acadenl) $ X ANY AUTO _ X 'A0083395001-2 07/10/2018 07/10/2019 BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOSE ONLY AUTOS yy BODILY INJURY(Per accident) $ X AUTOS ONLY X AUUTOS ONLYY PROPERTY acEcidentDAMAGE $ $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 15,000,000 EXCESS LIAB CLAIMS-MADE X A0083395007 07/10/2018 07/10/2019 AGGREGATE $ 15,000,000 DED X RETENTION$ 0 $ A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N A0083395006 07/10/2018 07/10/2019 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDEXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) PAGE 1 OF 2: Re: Street/Sidewalk Obstruction/Sidewalk Layers/Curb Cut Contractors/Work in Right-of-Way Licenses In regards to work performed by the insured, the City of Oshkosh,and it's officers council members, agents, employees and authorized volunteers CERTIFICATE HOLDER CANCELLATION OSHCITI 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 PO BOX 1130 215 CHURCH AVENUE AUTHORIZED REPRESENTATIVE OSHKOSH,WI 54903-1130 Troy Carlson I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD