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HomeMy WebLinkAboutTown & Country Underground Utility Construction 12-31-19 1 K ____........ TOWN&CO-01 LINZMAN ACdSPR0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIVYYY) 1/4..-------- 4/10/2019 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 suchppe77ndorsement(s). PRODUCER 1 L� NAMEACT Ann Linzmeyer The McGlone Agency,Inc. AHONN,Ext):(920)725-3232 FAX No 920 725-3233 885 Western Avenue n ( t }:( ) ^V 1 3 2ojJ E-MAIL ann.linzme er mcclone.com Suite 300b MAY ADDREss: _ -ann.linzmeyer@mcclone.com Du Lac,WI 54935 DI INSURER1S)AFFORDING COVERAGE NAIC H INSURED ntl( �)- II. It.1 ('()�N)(ll, \ INSURER B:Sen Middlesex try Insurance a Mutual Co 24988 Town&Country Underground Utility Construction Inc INSURER C:Capitol Specialty Ins Corp 10328 W2899 Dunn Road INSURER D: Mayville,WI 53050-2519 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR IN SD.WV0 IMMIDDIWYYI IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X CLAIMS-MADE OCCUR X A0089992004-2 12/31/2018 12/31/2019 DAMAGETO(Ea occu RENTED $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER' GENERAL AGGREGATE $ 3,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER' $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident) $ X ANY AUTO X A0089992001-2 12/31/2018 12/31/2019 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY _ AUTOS�� BODILY INJURY(Per accident) $ X AUTOS ONLY X AUUTOS ONLYY (Pere PROPERTY DAMAGE $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB ^ CLAIMS-MADE A0089992006-2 12/31/2018 12/31/2019 AGGREGATE $ 5,000,000 DED RETENTION$ $ B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN A0089992005-2 12/31/2018 12/31/2019 100,000 OFFICER/MEMBER/EXCLUDEDX?ECUTIVE N N I A E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Pollution EV20184600-01 12/31/2018 12/31/2019 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re:Right-Of-Way License.City of Oshkosh,and its officers,council members,agents,employees and authorized volunteers are named as additional insureds on a primary and non-contributory basis for on-going and completed operations on the General Liability(per forms CG2010 07/04 and CG2037 07104)and Auto Liability policies-when required by written contract.30 days notice of cancellation applies-except in the event of non-payment of premium,then 10 day notice. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Oshkosh,Attn:CityClerk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 215 Chruch Avenue PO Box 1130 Oshkosh,Wi 54903 AUTHORIZED REPRESENTATIVE /4,/17 ati — ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD