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HomeMy WebLinkAboutSommers Construction 1-1-19 X DATE(MM/DD/YYYY) AC� CERTIFICATE OF LIABILITY INSURANCE 3/7/2018 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_._ Julie Kinjerski Associated Benefits and Risk Consulting, LLC PHONE g20731 0400 jAIC,No1:920-731-4072 711 Eisenhower Drive 1AIC.No.Ext1: Kimberly WI 54136 ADDRESS: Julie.Kinjerski©AssociatedBRC.com INSURER(S)AFFORDING COVERAGE NAIC• INSURER A:Middlesex Insurance Company Assigned INSURED SOMMCON-01 INSURER B:Sentry Insurance Sommers Construction Co Inc W7841 Smith St INSURER C: Shiocton WI 54170-8599 INSURERD: INSURER E: _INSURER F: COVERAGES CERTIFICATE NUMBER:832989923 REVISION NUMBER: This IS TO CERTIFY THAT 1HE 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 ADDLISUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR yyVD POLICY NUMBER (MMIDDM/YYI IMMIDD/YYYYI. A GENERAL LIABILITY Y A0091981004 1/1/2018 1/1/2019 EACH OCCURRENCE $1,000,000DAMAGE X COMMERCIAL GENERAL LIABILITY PREM SESO(EaENTED occurrence) S 500.000 CLAIMS-MADE I X OCCUR MED EXP(Any one person) S 10,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X JE-. LOC S A AUTOMOBILE LIABILITY A0091981001 1/12018 1/1/2019 COMBINED SINGLE LIMIT (Ea accident) $1 000,000 X ANY AUTO I BODILY INJURY(Per person) $ ALL OWNED SCHEDULED f BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-0WNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) S A X UMBRELLA LIAB X I OCCUR A0091981006 1/1/2018 1/1/2019 EACH OCCURRENCE $8,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $8,000,000 DEC—IT X f RETENTIONS 0 S 8 WORKERS COMPENSATION A0091981005 1/1/2018 1/12019 X WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? NIA - (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000. If yes descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500.000 I I 1 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) The following forms apply to the name(s)/project(s)listed below only if required by written contract or agreement: General Liability: CG 20 10,CG 20 37&CG 20 01 Additional Insured(primary and noncontributory included completed operation).CG 24 04 Waiver of Transfer of Rights of Recovery;Auto Liability:CA 76 01 Additional Insured(primary&noncontributory)&CA 04 44 Waiver of Transfer of Rights of Recovery;Workers Compensation: WC 00 03 13 Waiver of Transfer of Rights of Recovery;Umbrella: Follow form Additional insured: City of Oshkosh and its officers,council members,agents,employees and authorized volunteers 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's Office 215 Church Avenue AUTHORIZED REPRESENTATIVE P0 Box 1130 Oshkosh WI 54903-1130 7(7 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD