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HomeMy WebLinkAboutRoe Nurseries 10-23-19 ACC OR CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 10/19/2018 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 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 NAME: Ann Wehrle Ansay&Associates, LLC. PHONE FAX 4351 W College Ave E A Lo.Ext): 920-560-7000 (A/c,No):920-560-7078 Suite 310 ADDRESS: ann.wehrle@ansay.com Appleton WI 54914 INSURER(S)AFFORDING COVERAGE NAIC 8 INSURER A:West Bend Mutual Insurance Company 15350 INSURED ROENURS-02 INSURER B: Roe Nurseries Inc 72 Waukau Avenue INSURER C: Oshkosh WI 54902 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 118573851 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 SUER POLICPOLICY NUMBER (MM DDY EFF POLICY EXP TYPE OF INSURANCE INSD LTR INSD WVD IYYYY) (MM/DDIIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 0147578 10232018 10/23/2019 EACH OCCURRENCE $1,000,000 DAMAGE RENTED _ CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $200.000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY JET _ LOC PRODUCTS-COMP/OP AGG $2,000.000 OTHER. A AUTOMOBILE LIABILITY 0147578 10232018 10/23/2019 COMBINED SINGLE LIMIT S (Ea accident) 1.000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X N -O AUTONOSWNED (Pe acEcidentDAMAGE $ A UMBRELLA LIAB X OCCUR 0147578 10/23/2018 10/23/2019 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ l $ A WORKERS COMPENSATION 0082634 10/23/2018 10/23/2019 I PEATUTE I PER OOTH I AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE N IA E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $100.000 li yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RECCATED LOC'1252018 CERTIFICATE HOLDER CANCELLATION iignIMMTAILIIMMI__ • SHOULD ANY OF THE ABOVE DESCRIBED PC"."31117 CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Oshkosh 215 Church Avenue Oshkosh WI 54901 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD /A