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HomeMy WebLinkAboutTDS Metrocom 1-1-19 ACC)R E•® DATE(MM/DO/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 01/03/2018 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 MARSH USA INC. PHON: 540 W.MADISON LVC No.Eat): FAX No): CHICAGO.IL 60661 EMAIL Attn:Chicago.CertRequest@marsh.com I Fax:212-948-0770 ADDRESS: _ — INSURER(S)AFFORDING COVERAGE NAIC X CT EXP 123113 PROP INSURER A:Sentry Casualty Company 28460 INSURED INSURER B:Sentry Insurance A Mutual Company 24988 TELEPHONE AND DATA SYSTEMS,INC. TDS METROCOM,LLC INSURER C:N/A N/A 30 N.LASALLE STREET INSURER D: SUITE 4000 CHICAGO,IL 60602 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: CHI-008419972-44 REVISION NUMBER: 16 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 INSD POUCY EFF POUCY EXP LTR INSD WVD POLICY NUMBER M D(YYYYI (MMIDD/YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY 90-02578-11 01/01/2018 01/01/2019 EACH OCCURRENCE $ 2,000,000 DAMAGE To CLAIMS-MADE I X 1 OCCUR PREMISES(EaENTED occurrence) $ 2,000,000 MED EXP(My one person) $ 10'000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ 90-02578-04 01/01/2018 01/01/2019 COMBINED SINGLE LIMIT $ 5,000,000 B AUTOMOBILE LIABILITY (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per a cident UMBRELLA LIAB - OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 90-02578-01(DED) (AOS) 01/01/2018 01/01/2019 X PER oTH- AND EMPLOYERS'LIABILITY STATUTE ER A ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N 90-02578-02 (MA,NY,WI,ND,OH,WA) 01/01/2018 01/01/2019 E.L.EACH ACCIDENT $ 1,000 000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1•�� I I 1 DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re:Annual License,Citywide City of Oshkosh,and its officers,council members.agents,employees and authorized volunteers is/are included as additional insured as respects operations Ypr EtilDl FAIjned ins ed as required by written contract. This insurance is Primary and Non-Contributory over any existing insurance and limited to liability arising out of the operations o the �111�dartdWhere required y itten contract. FEB 0 6 2018 CLERIC'S®II[CE CERTIFICATE HOLDER CANCELLATION City of Oshkosh SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 215 Church Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Oshkosh,WI 54901 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee -.INt.aluDo1--;- I ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD