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HomeMy WebLinkAboutWisconsin Public Service Corporation 10-1-19 A C27/2018 DATE(MM/DD/YVYY) R� CERTIFICATE OF LIABILITY INSURANCE 9/MMIDDrY 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 Stephens Insurance, LLC NAME:_ Tricia Brazil 111 Center Street, Suite 100 PHONE FAx Little Rock, AR 72201 Eat)::E-MAIL IL 800-852-5053 (NC,Not: 501-210-4683 E-MAIL ADDRESS: tricia.brazil@stephens.com INSURER(S)AFFORDING COVERAGE _ NAIC N www.stephensinsurance.com INSURER A: Associated Electric&Gas Ins.Services,Ltd. INSURED INSURER B: Wisconsin Public Service Corporation c/o WEC Energy Group, Inc. INSURER C: _ INSURER D: 231 West Michigan Street P378 INSURER E: Milwaukee WI 53203 - INSURERF: COVERAGES CERTIFICATE NUMBER: 44486391 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. IR' AINSD yy D POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER (MMIDDlYYYY) (MM/DDlYYYY) LIMITS COMMERCIAL GENERAL LIABILITY ✓ NA 10/1/2018 10/1/2019 EACH OCCURRENCE S _ CLAIMS-MADE ( OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ ✓ Self Insured _ MED EXP(Any one person) S _ PERSONAL&ADVINJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY PRO-JECT LOC PRODUCTS-COMP/OP AGG S OTHER: S AUTOMOBILE LIABILITY NA 10/1/2018 10/1/2019 (EaaBcideDISINGLE LIMIT $ 1 ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) S HIRED NON-OWNED PROPERTY DAMAGE S ,AUTOS ONLY AUTOS ONLY (Per accident) _ ✓ Self Insured $ A UMBRELLA LIAB OCCUR ✓ XL5044008P 10/1/2018 10/1/2019 EACH OCCURRENCE S 2,000,000 / EXCESS UAB ✓ CLAIMS-MADE Excess Auto Liability AGGREGATE S Per Policy DED ✓ RETENTION$Per Policy Excess Employer Liability S WORKERS COMPENSATION NA 10/1/2018 10/1/2019 AND EMPLOYERS'LIABILITY YIN Self-Insured STATUTE ✓ ERH ANYPROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S DSC.RIePO OnFd OPERATIONS PERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Oshkosh,&its officers council members,agents,employees and authorized volunteers is an Additional Insured under the Policy on a primary and non-contributory basis but only i)to such extent and for such Limits of Liability(subject always to the terms and Limits of Liability of the Policy)as the Named Insured has agreed to provide insurance for the Certificate Holder under the following Contract: Wisconsin Public Service Corporation to perform work in the City of Oshkosh regarding manufactured gas plant site CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. P. O. Box 1130 Oshkosh WI 54903-1130 AUTHORIZED REPRESENTATIVE James Fortner ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 44486391 118-19 New SI COI Liberty Holders I Tricia Brazil 19/27/2016 10:59:28 AM (CDT) I Faye 1 of .. This certificate cancels and supersedes ALL previously issued certificates.