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HomeMy WebLinkAboutWolf River Asphalt and Sealcoating 3-16-19 TE ACORE1® CERTIFICATE OF LIABILITY INSURANCE DA08/10/2018Y) 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 Michele Daniels NAME Family Insurance Center. LLC PHONE FAX N1788 Lily of the Valley Dr (Arc.No.ex11: (920)757-1010 (AlC No):(920)757-9710 Greenville,WI 54942 E-MAIL Michele@familyinsctr.com insctr.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC■ INSURER A: Erie Insurance 26271 INSURED WOLF RIVER ASPHALT AND SEALCOATING, INC INSURERB: CNA Surety CNA N5206 Rexford Rd Shiocton,WI 54170 INSURER C: INSURER D: 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. LTR TYPE OF INSURANCE u Si L SUBRwvo POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MMIDDlYYYYI fMM/DDIYYVYI A ✓COMMERCIAL GENERAL LIABILITY Y Q39-1650891 03/16/2018 03/16/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO CLAIMS-MADE V OCCUR PREMISES(Ea occuED ence) S 1,000,000 MED EXP(My one person) S 5,000 • PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JET LOC PRODUCTS_COMP/OP ADD $ 2,000,000 OTHER: - - --- S A AUTOMOBILE LIABILITY Y Q03-1640079 03/16/2018 03/16/2019 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ — OWNED _ / SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY V AUTOS HIRED _ / NON-OWNED PROPERTY DAMAGE AUTOS ONLY V AUTOS ONLY (Per accident) $ A V UMBRELLA LIAB OCCUR Y Q27-1670325 03/16/2018 03/16/2019 EACH OCCURRENCE S 2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTION S -n S A WORKERS COMPENSATION Q87-1600839 03/16/2018 03/16/2019 V STATUTE ERA AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? 1-1NIA (Mandatory In NH) E.L DISEASE-EA EMPLOYEE S 1,000,000 M yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Annual Excavation/Work in 63759630 08/10/2018 08/10/2019 $5,000 Right-of-Way Bond DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) 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. PO Box 1130 Oshkosh,WI 54903 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD