HomeMy WebLinkAboutUnited Concrete & Construction 7-1-19 ACORO CERTIFICATE OF LIABILITY INSURANCE DATE05/09/D/YYYV)
S/09/2018
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
NAME: CLIENT CONTACT CENTER
FEDERATED MUTUAL INSURANCE COMPANY
PHONE HOME OFFICE: P.O. BOX 328 (A/C,C,No,Eet):888-333-4949 (A/C,No):507-446-4664
OWATONNA, MN 55060 E-MAIL
CLIENTCONTACTCENTER(a FEDINS.COM
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED 391-359-7 INSURER B:
UNITED CONCRETE &CONSTRUCTION INC INSURER C:
5902 N RICHMOND ST
APPLETON,WI 54913-9642 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 12 REVISION NUMBER:0
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
LTR INSR WVD (MM/DD/YYYYI (MM/DD/YYYY) LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000
CLAIMS-MADE X OCCUR DAMAGE TO RENTED $100,000
PREMISES(Ea occurrence)
MED EXP(Any one person) EXCLUDED
A Y N 6048574 07/01/2018 07/01/2019 PERSONAL a ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
PRO-
X POLICY JECT LOC PRODUCTS-COMP/OP AGG $2,000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
(Ea accident)
X ANY AUTO BODILY INJURY(Per person)
OWNED AUTOS ONLY SCHEDULED
A AUTOS N N 6048574 07/01/2018 07/01/2019 BODILY INJURY(Per accident)
NON-OWNED
HIRED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE
(Per accident)
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $1,000,000
A EXCESS LIAB CLAIMS-MADE N N 6048577 07/01/2018 07/01/2019 AGGREGATE $1,000,000
DED RETENTION
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY Y/N X PER STATUTE OER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000
A OFFICER/MEMBER EXCLUDED? N I A N 6048575 07/01/2018 07/01/2019
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000
II yes,describe under E.L DISEASE-POLICY LIMIT $500,000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule.may be attached if more space is required)
THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES
OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY.
CERTIFICATE HOLDER LMAY
CANCELLATION
391-359-7 142 i 8 ,2CITY OF OSHKOSH -CITY CLERK ISHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
PO BOX 1130 - THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN
OSHKOSH,WI 54903-1130 % Cr..,CLERK'S OtI( t. ACCORDANCE WITH THE POUCY PROVISIONS.
AUTHORIZED REPRESENTATIVE
/1/401,Vd )(tA".
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