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HomeMy WebLinkAboutTrico Excavating 4-10-19 ACOREP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 03/21/2019 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 such endorsement(s). PRODUCER CONTACT NAME: Theresa Vorpahl PHFox Cities Insurance Agency Inc We N .Ems: (920)739-0424 NE FAX NO): (920)739-3536 ML 1204 N Mason St ADDREss: Theresav@foxcitiesinsurance.com Appleton,WI 54914 INBURER(8)AFFORDINGCOVERAGE NAICiI INSURERA: West Bend Mutual Ins.Co. 15350 INSURED INSURER B: Trico Excavating Inc Bill Rathsack INSURERC: 5400 N Richmond St INSURER D: Appleton, WI 54913-9726 INSURERS: INSURER F: COVERAGES CERTIFICATE NUMBER: 00000000-1169849 REVISION NUMBER: 10 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 EFF POLICY EXPWWI /Y LIMITS LTR INSD W POLICY NUMBER (MM/DDYYYI IMM/DDIYYYYI A X COMMERCIAL GENERAL LIABILITY 0066764 04/10/2018 04/10/2019 EACH OCCURRENCE S 1,000,000 E TO CLAIMS-MADE I X.] OCCUR PREMISES(EsENTtD occuence) $ 200,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000_ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ -2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABIUTY 0066764 04/10/2018 04/10/2019 COMBINED SINGLE LIMIT $ 1,000,000 1. ANY AUTO BODILY INJURY(Per person) $ OWNED r-- SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) NO $ A X UMBRELLA LIAB OCCUR 0066764 04/10/2018 04/10/2019 EACH OCCURRENCE $ 5,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ A WORKERS COMPENSATION 0066766 04/10/2018 04/10/2019 X STATUTE ERH AND EMPLOYERS'LIABILITY — - ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? y N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 A Equipment Loaned,Lea 0066764 04/10/2018 04/10/2019 Limit $125,000 or Rented DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) City of Oshkosh, & its officers, council members, agents,employees&authorized volunteers shall be additional insured. 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. 215 Church Ave. Oshkosh,WI 54901 AUTHORIZED REPRESENTATI �i py� faw� (TMV) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by TMV on March 21,2019 at 03:25PM