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HomeMy WebLinkAboutRJ Albright 1-1-19 ou. CERTIFICATE OF LIABILITY INSURANCE °ATE(MM/2017 Y' 1 2/1 51201 7 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 ,01�— certificate does not confer rights to the certificate holder in lieu of such endorsement(s). c CONTACT O7 PRODUCER 15 — NAME: Aon Risk Services Central, InC. PHONE (920) 437-7123 FAX (920) 431-6345 d Green Bay WI Office (A/C.No.Eel): (AIC.No.): V 111 N. Washington Street, Suite 300 E-MAIL -0- P. O. Box 23004 ADDRESS: I Green Bay WI 54305-3004 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: ACUITY, A Mutual Insurance Company 14184 R. J. Albrioht, Inc. INSURERB: 5711 Green Valley Road Oshkosh WI 54904 USA INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570069487396 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. Limits shown are as requested INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER ((MMIDDIYYYY11 MM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY L74803 01/01/2018 01/01/2019 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR GENERAL LIABILITY DAMAGE TO RENTED $250,000 PREMISES(Ea occurrence) MED EXP(Any one person) $10,000 PERSONAL B ADV INJURY 81,000,000 T, to GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $3,000,000 h- .:, POLICY I I JE X LOC PRODUCTS CT -COMP/OP AGG S3,000,000 up OTHER o A AUTOMOBILE LIABILITY L74803 -01/01/201801/01/2019 COMBINED SINGLE LIMIT S1,000,000 N AUTO LIABILITY (Ea accident) X ANY AUTO BODILY INJURY(Per person) 0 OWNED SCHEDULED BODILY INJURY(Per accident) di AUTOS ONLY AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE V ONLY AUTOS ONLY (Per student) w S a) A X UMBRELLALIAB X OCCUR L74803 01/01/2018 01/01/2019 EACH OCCURRENCE S5,000,000 0 UMBRELLA AGGREGATE $5,000,000 EXCESS LIAR CLAIMS-MADE DED RETENTION A WORKERS COMPENSATION AND L74803 01/01/2018 01/01/2019 X PER OTH- EMPLOYERS'LIABILITY YIN WORKERS COMPENSATION STATUTE ER ANY PROPRIETOR I PARTNER 1 EXECUTIVE E.L.EACH ACCIDENT 8100,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000— n DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) ix- kl n CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE C EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE M POLICY PROVISIONS. CITY OF OSHKOSH AND CHAMCO, INC. AUTHORIZED REPRESENTATIVE PO BOX 1130 Zy OSHKOSH WI 54903-1130 USA . �z 4- a ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD