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HomeMy WebLinkAboutSecurity Luebke Roofing 5-1-19 AC-O® DATE(MMIDDIYYVV) CERTIFICATE OF LIABILITY INSURANCE 4/24/2018 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 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 CONTACT M3 Insurance Solutions, Inc. PHONE Tiffanie Courtney FAX 480 Pilgrim Way, Suite 1230 LAIC,No.Ext):920-405-9162 (A/c,No):920-405-9169 E-MGreen Bay WI 54304 ADDRESS: tiffanie.courtney@m3ins.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Acuity Insurance Company 14184 INSURED SECUL-1 INSURER B:West Bend Mutual Insurance 15350 Security-Luebke Roofing, Inc. 2251 Progress Way INSURER C: Kaukauna WI 54130 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1879117902 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 N (MM/ SD WVD POLICY NUMBER POLICY EFF POLICY LIMITS DD/YYYY) (MM/DD/YYYYT Y) A X COMMERCIAL GENERAL LIABILITY Z19700 5/1/2018 5/1/2019 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $250,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE $3,000,000 POLICY X PE X LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER $ A AUTOMOBILE LIABILITY Z19700 5/1/2018 5/1/2019 COMBINED SINGLE LIMIT $1 000 000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) A X UMBRELLALIAB X OCCUR Z19700 5/1/2018 5/1/2019 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED I X RETENTION$0 $ B 'WORKERS COMPENSATION 1857752 5/1/2018 5/1/2019 X PER ' OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) - E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under _DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500.000 A Leased/Rented Equipment Z19700 5/1/2018 5/1/2019 Leased/Rented Equip 150.000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) The City of Oshkosh and its officers,council members,agents,employees and authorized volunteers are listed as additional insureds with respect to general liability and auto liability per the policy forms,conditions and exclusions. 30 day Notice of Cancellation is included. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Oshkosh ACCORDANCE WITH THE POLICY PROVISIONS. City Clerk PO Box 1130 AUTHORIZED REPRESENTATIVE Oshkosh WI 54903-1130 Qr511U1Xt ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD