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HomeMy WebLinkAboutTom Van Handel Corp 2-1-19 ACoRO CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDlYYYY) 2/2/2018 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 (A/C.No.Exq-920-455-7102 (A/C,No): Green Bay WI 54304 ADDREss: tiiffanie.courtney@m3ins.com INSURER(S)AFFORDING COVERAGE NAIC N INSURERA:Acuity Insurance Company 14184 INSURED VANHT-1 INSURERB:Starr Indemnity and Liability Tom Van Handel Corp. 1830 E. Edgewood Drive INSURER C: Appleton WI 54913 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1508435340 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 SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MMlDDlYYYY) (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABIUTY Y Y Z12983 2/1/2018 2/1/2019 EACH OCCURRENCE $1,000,000 DAGE TO CLAIMS-MADE X OCCUR PREM SES(EaENTED 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 JECT X LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER: $ A AUTOMOBILELUâ–şBIUTY Y Y Z12983 2/1/2018 2/1/2019 COMBINED SINGLE LIMIT $ (Ea accident) 1,000.000 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 UMBRELLA LIAR X OCCUR Y Y Z12983 2/1/2018 2/1/2019 EACH OCCURRENCE $5,000,000 X EXCESS UAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$0 $ A WORKERS COMPENSATION Z12983 2/1/2018 2/1/2019 XTH- AND EMPLOYERS'LIABILITY -_ STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 lit yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 B Leased/Rented Equipment ITC100070340018 2/1/2018 2/1/2019 Leased/Rented Equipt 250,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Oshkosh, its Officers,Council Members,Agents, Employees, and Authorized Volunteers are included as Additional Insureds with respects to General Liability where required by written contract. '(` 30 day Notice of Cancellation,to the Certificate Holder, is included on the policy. R X ICED FEB 062018 ary r-toRK' O [c ,10 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 215 Church Street AUTHORIZED REPRESENTATIVE Oshkosh WI 54901-4747 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD