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HomeMy WebLinkAboutStatewide Razing 11-22-19 ACORia CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �� 11/13/2018 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). CONT PRODUCER NAMEACT Sheila Ipsen _ Bay Insurance Agency, Inc. (A/C.No.Exn; (920)339-8262 (A/C,No): (920)339-8294 3136 Holmgren Way, P.O. Box 28077 ADDRESS: slpsen@bayinsagency.com _ Green Bay, WI 54324-0077 INSURER{S)AFFORDING COVERAGE NAICI INSURER A: United National INSURED INSURER B: Society Insurance 15261 Statewide Razing Inc.&Martin Recycling, Inc. INSURER C: Merchants National . W1198 County Trunk Kk INSURER 0: Amerisafe Kaukauna, WI 54130 INSURERE: Everest Indemnity Ins INSURER F: COVERAGES CERTIFICATE NUMBER: 00000000-2129815 REVISION NUMBER: 85 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 LTR TYPE OF INSURANCE INS(WVID POLICY NUMBER BR POLICY EFF POLICY EXP LIMITS . (M MIODIYYYYI I M M/DD/riril A X COMMERCIAL GENERAL LIABILITY L7219828-E 11/22/2018 11/22/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 X contractual liabili PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ B AUTOMOBILE LIABILITY CAP 517464 11/07/2018 11/07/2019 (EO aBc NdeDtSINGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS HIRED NOTON- D PROPERTY DAMAGE $ X AUTOS ONLY X AUSOWNE ONLY (Per accident) X Owned Private P)EpsOwned Autos OJT Pri $ G` X UMBRELLA LIAB X OCCUR EXL000014218 11/22/2018 11/22/2019 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 OW X RETENTIONS 0 $ D AND EMPLOYERS'WORKERS N ABILOITY Y/N AVWC WI258167201 03/26/2018 03126/2019 X STATUTE EERH ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N 1 A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 E Environmental EF4P001915-121 11/22/2018 11/22/7019 1000000 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Oshkosh is also listed as additional insured. Project: Demolition of Residential Dwelling at 526 Pleasant St Oshkosh WI 54901 L— _____ CITY C 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 Purchasing ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1130 Oshkosh, WI 54902-1130 AUTHORIZED REPRESENTATIVE (40 k.g (SRI) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by SRI on November 13,2018 at 01:25PM