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HomeMy WebLinkAboutStafford Construction 4-20-19 STAFCON-01 MHOBBS CC--;ORQ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/15/2018 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 NAME: The Diedrich Agency PHONE 303 High Avenue (A/C,No,Ext):(920)232-4090 I I,v,No):(920)748-5044 Oshkosh,WI 54902 E-MAIL ADD DD RESS: INSURER(S)AFFORDING COVERAGE NAIC I INSURER A:Acuity 14184 INSURED INSURER B: STAFFORD CONSTRUCTION RANDY STAFFORD DBA INSURER C: 4237 ST RD 21 INSURER D: OSHKOSH,WI 54904 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DD/YYYYI IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X X40826 04/20/2018 04/20/2019 PREMISES(eaENTED occurrenceI $ 250,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 3,000,000 POLICY gla LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: S A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT(Ea accident) S 1,000,000 ANY AUTO X40826 04/20/2018 04/20/2019 BODILY INJURY(Per person) $ OWNED AUTOS ONLY X AUUOTTNOSWULNEEDp BODILY INJURY(Per accident)_ $ X AUTOS ONLY X !MAW (Per a cide tDAMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABIUTY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE X40826 04/20/2018 04/20/2019 100,000 FFICER/ME M R EXCLUDED? y N/A EL EACH ACCIDENT S (Mandatory In NH) 100,000 E.L.DISEASE-EA EMPLOYEE S If es,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS J VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Oshkosh and its officers,council members,agents,emplohyees and authorized volunteers Randy Stafford is excluded from coverage under workers compensation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 420 Jackson Street Oshkosh,WI 54901 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD