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Home My WebLink AboutRasmussen, Joseph 8-31-19 CERTIFICATE OF LIABILITY INSURANCE ' American Family Insurance Company ❑ American Family Mutual Insurance Company,S.I. if selection box is not checked. 6000 American Pky Madison,Wisconsin 53783-0001 Insured's Name and Address Agent's Name,Address and Phone Number(Agt./Dist.) Joseph Rasmussen APR 1 0 2019 Curt L Stam 5135 Angle Rd 1920 S Washburn St Oshkosh, WI 54904 DEPT OF PUBLIC WORK Oshkosh, WI 54904 OSHKOCI I 1VICf(Ni'. (920) 235-1776 (102/015) This certificate is issued as a matter of information only and confers no rights upon the Certificate Holder. This certificate does not amend,extend or alter the coverage afforded by the policies listed below. COVERAGES This is to certify that 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,ant conditions of such policies. POLICY DATE TYPE OF INSURANCE POLICY NUMBER EFFECTIVE EXPIRATION LIMITS OF LIABI_ITY (Mo,Day,Yr) (Mo,Day,Yr) Homeowners/ Bodily Injury and Property Damage Mobilehomeowners Liability Each Occurrence $ ,000 Boatowners Liability Bodily Injury and Property Damage Each Occurrence $ ,000 Personal Umbrella Liability Bodily Injury and Property Damage Each Occurrence $ ,000 Farm Liability&Personal Liability Farm/Ranch Liability Each Occurrence 000$ Farm Employer's Liability Each Occurrence $ ,QQi) Statutory Workers Compensation and Each Accident $ ,00 Employers Liability t Disease-Each Employee $ CO, ' Disease-Policy Limit $ ,CO General Liability General Aggregate $ 2,000,C0 Commercial General Products-Completed Operations Aggregate $ 2,000,C0 Liability(occurrence) Personal and Advertising Injury $ 1,000,00•) ❑ 48-XV7906-02 08/31/2018 08/31/2019 $ 1,000,OQ;) Each Occurrence ❑ Damage to Premises Rented to You $ 100,00) Medical Expense(Any One Person) $ 10,00;) Each Occurrencett $ ,001)y Businessowners Liability Aggregatett $ OOU Liquor Liability Common Cause Limit $ ,000 Aggregate Limit $ 000 Automobile Liability Bodily Injury-Each Person $ 250,000 1 Any Auto ❑ All Owned Autos Bodily Injury-Each Accident $ 500,00 J ❑ Scheduled Autos 48-VX7906-01 08/31/2018 08/31/2019 Property Damage $ 100,000 ❑ Hired Auto _ ❑ Nonowned Autos Bodily Injury and Property Damage Combined $ 600,00011 Excess Liability ❑ Commercial Blanket Excess Each Occurrence/Aggregate $ ,000 ❑ _ Other(Miscellaneous Coverages) DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS I SPECIAL ITEMS tThe individual or partners [j Have shown as insured elected to be covered under this policy. ❑Have ncr ttProducts-Completed Operations aggregate is equal to each occurrence limit and is included in policy aggregate. CERTIFICATE HOLDER'S NAME AND ADDRESS CANCELLATION Should any of the above described policies be cancelled before the expiration data City of Oshkosh, Attn: City Clerk thereof, the company will endeavor to mail`( days)written notice to the Certificate 215 Church Avenue Holder named,but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives. `10 days unless different number of days PO Box 1130 shown. [x] This certifies coverage on the date of issue only. The above described policies are Oshkosh WI 54903-1130 subject to cancellation in conformity with their terms and by the laws of the state of issue. DATE ISSUED ' AUTHORIZED REPRESENTATIVE 04/08/2019 Susan Klitzke U-201 Ed.5/00 Stock No. 06668 Rev. 7/I)2 CERTIFICATE OF LIABILITY INSURANCE American Family Insurance Company ❑ American Family Mutual Insurance Company,S.I. if selection box is not checked. 6000 American Pkv Madison.Wisconsin 53783-0001 Insured's Name and Address Agent's Name.Address and Phone Number(Agt./Dist.) Joe Frank Rasmussen Curt L Stam 5135 Angle Rd 1920 S Washburn St Oshkosh,WI 54904 Oshkosh, WI 54904 (47fl 7(6-177R (1n7/n151 This certificate is issued as a matter of information only and confers no rights upon the Certificate Holder. This certificate does not amend,extend or alter the coverage afforded by the policies listed below. COVERAGES This is to certify that 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. POLICY DATE TYPE OF INSURANCE POLICY NUMBER EFFECTIVE EXPIRATION LIMITS OF LIABILITY (Mo,Day,Yr) (Mo,Day,Yr) Homeowners/ Bodily Injury and Property Damage Mobilehomeowners Liability Each Occurrence $ ,000 Boatowners Liability Bodily Injury and Property Damage Each Occurrence $ ,000 Personal Umbrella Liability Bodily Injury and Property Damage Each Occurrence $ ,000 Farm Liability&Personal Liability Farm/Ranch Liability Each Occurrence $ 000 Farm Employer's Liability Each Occurrence $ ,000 Statutory Workers Compensation and Each Accident $ ,000 Employers Liability t Disease-Each Employee $ ,000 •Disease-Policy Limit $ ,000 General Liability General Aggregate $ 2000 ,000 ❑ Commercial General Products-Completed Operations Aggregate $ 2000 ,000 Liability(occurrence) 48 XV7906 02 38/31/2018 38/31/2019 Personal and Advertising Injury $ 1000 ,000 ❑ Each Occurrence $ 1000 ,000 ❑ Damage to Premises Rented to You $ 100 ,000 Medical Expense(Any One Person) $ 10 ,000 Businessowners Liability Each Occurrencett $ 000 Aggregatett $ ,000 Liquor Liability Common Cause Limit $ ,000 Aggregate Limit $ ,000 Automobile Liability Bodily Injury-Each Person $ 250 .000 lid Any Auto El All Owned Autos Bodily Injury-Each Accident $ 500 ,000 El Scheduled Autos 48-XV-7906-01 38/31/2018 38/31/2019 Property Damage $ 100 ,000 ❑ Hired Auto ❑ Nonowned Autos Bodily Injury and Property Damage Combined $ 350 ,000 Excess Liability ❑ Commercial Blanket Excess Each Occurrence/Aggregate $ ,000 Other(Miscellaneous Coverages) DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS tThe individual or partners ❑Have The Cityof Oshkosh, and its officers, council members, employees and authorized volunteers shownasin suredelectedto be covered under this policy. ❑Have not shall be listed as an additional insured ttProducts-Completed Operations aggregate is equal to each occurrence limit and is included in policy aggregate. CERTIFICATE HOLDER'S NAME AND ADDRESS CANCELLATION ❑ Should any of the above described policies be cancelled before the expiration date City of Oshkosh, Attn: City Clerk thereof,the company will endeavor to mail*( days)written notice to the Certificate 215 Church Avenue Holder named,but failure to mail such notice shall impose no obligation or liability of any kind upon the company,its agents or representatives.*10 days unless different number of days shown. PO Box 1130 Oshkosh WI 54903-1130 IJ This certifies coverage on the date of issue only.The above described policies are subject to cancellation in conformity with their terms and by the laws of the state of issue. DATE ISSUED AUTHORIZED REPRESENTATIVE 04/11/2019 Susan Klitzke U-201 Ed.5/00 Stock No.06668 Rev.7/02