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HomeMy WebLinkAboutRaiserite Concrete Lifting 1-1-19 �—.440 RAISCON-02 LHINTZE ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD VYYY) �� 12/27/2017 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 ACT Jeffrey Cardenas Vizance,Inc. PHO 1320 Walnut Ridge Dr.Ste.200 (A/C, Ext):(262)367-86I 1302 I (AA/CC,No): Hartland,WI 53029 5-edl Ss:jcardenas@vizance.com INSURER(S)AFFORDING COVERAGE NAIC I INSURER A:Acuity 14184 INSURED INSURER B: Raiserite Concrete Lifting Inc RaiseRite Foundation Pier INSURER C: Systems,Inc. 1025 E.Albert Dr. INSURER D: Manitowoc,WI 54220 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM(DDIYYYY) IMM/DD(YYYYI A X COMMERCIAL GENERAL UABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X86313 01/01/2018 01/01/2019 DAMAGE TO RENTED 100,000 X PREMISES(Ea occurrence) 5 MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ CMBINED A AUTOMOBILE LIABILITY Ea accident SINGLE LIMIT $ 1,000,000 X ANY AUTO X X86313 01/01/2018 01/01/2019 BODILY INJURY(Per person) S OWNED EOS ONLY SCHEDULED SSVUyLNED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS ONLY PROPERTY acciiident�AMAGE $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE X86313 01/01/2018 01/01/2019 AGGREGATE 5,000,000 DED X RETENTIONS 0 $ A WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY X86313 01/01/2018 01/01/2019 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y 1 N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? Y NIA SOO,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,descnbe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Oshkosh,its officers,council members,agents,employees and authorized volunteers shall be named additional ins - ' t1'r•�the 11 General Liability and Auto Liability,as required by written contract.General Liability is on a primary and non-contribute -bisisal , �, •• completed operations coverage. A 30-day Notice of Cancellation applies. LDEC $ 8 2017 CITY 0-01 's CIF C� CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Ave. P.O. Box 1130 Oshkosh,WI 54903-1130 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD