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HomeMy WebLinkAboutW&D Navis 7-1-19 �...40 W&DNAVI-01 HTENPASS AC RO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 06/20/2018 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). _ CONTACT PRODUCER NAME: ------Sterk Insurance Agency,Inc. PHONE (A/C, En);(920)324-2071 iIAA c,No):(920)324-5057 999 West Main St. E-MAIL P.O.Box 72 ADDRESS' -- - --- Waupun,WI 53963 I INSURER(S)AFFORDING COVERAGE NAIge INSURER A:West Bend Mutual Ins CO. 15350 INSURED INSURERS: W&D Navis,Inc. INSURERC_ P.O. Box 48 INSURER D: Waupun,WI 53963 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. 1� I IADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP TYPE OF INSURANCE INSD WVD (MM/DD/YYYY1 IMM/DD/YYYYI, LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 I DAMAGE TO RENTED 200,000 CLAIMS-MADE X OCCUR I 1 0176881 07/01/2018 07/01/2019 PREMISES(Ea acaxrence) S MED EXP(Any one Person) S 10,000 PERSONAL&ADV INJURY i 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 ' POLICY X ypef LOC PRODUCTS-COMP/OP AGG i _ 2,000,000 OTHER: 3 COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILE LIABILITY (Ea accident) i X ANY AUTO 0176881 07/01/2018 07/01/2019 BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY BODILY INJURY(Per accident) S AUTOS ONLY OS ON (`Purr ))PROPERTYIWMAGE $ S A X UMBRELLA LAB I X I OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAR CLAIMS-MADE 0176881 07ro1/2018 07/01/2019 AGGREGATE $ 5,000,000 ' DED RETENTIONS $ — A WORKERS COMPENSATION X STATUTE OER TH AND EMPLOYERS'LIABILITY YIN 0178506 07/01/2018 07/01/2019 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA E.L EACH ACCIDENT i OFFICER/MEMBER EXCLUDED? 100,000 (Mandatory In NH) E.L DISEASE-EA EMPLOYEE S If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ A Leased/Rented Equip. 0176881 07/01/2018 07/01/2019 310,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Blanket Additional Insured,as required by written contract,to the General Liability with respect to work performed by the 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. P.O.Box 1130 Oshkosh,WI 54901-1130 - AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD