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HomeMy WebLinkAboutZillges Materials 7-1-19 CO® DATE(MMIDDM(YY) A ` O CERTIFICATE OF LIABILITY INSURANCE 2/11/2019 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 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). CONTPRODUCER NAMEACT Ann Wehrle Ansay&Associates, LLC. -OSH PHONE g20-235 2764 FAX 430 920-235-2694 430 N. Koeller Street (A/c.No.Exta Oshkosh WI 54902 ADDRESS: ann.wehrle@ansay.com INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A:West Bend Mutual Insurance Company 15350 INSURED ZILLMAT-03 INSURER B: Zillges Materials, Inc. 1990 W Snell Road INSURER C: Oshkosh WI 54904 INSURERD: INSURER E: _ INSURER F: COVERAGES CERTIFICATE NUMBER:706575257 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. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER IMD LTR INSD //YYYY) IMM/DD/YYYYI LIMITS LT WVD POLICY A X COMMERCIAL GENERAL LIABILITY 0708525 7/1/2018 7/1/2019 EACH OCCURRENCE S 1,000,000 DAMAGE X PREMISES occurrence)NTED CLAIMS-MADE OCCUR 5200.000 —. MED EXP(Any one person) $10,000 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY J X PROECT- LOC PRODUCTS-COMP/OP AGG $2,000,000 — OTHER $ A AUTOMOBILE UABILITY 0708525 7/1/2018 7/1/2019 COMBINED SINGLE LIMIT $ (Ea accident) 1.000.000 X ANY AUTO BODILY INJURY(Per person) $ ' ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ , AUTOS AUTOS NON-OWNED $ �i X HIRED AUTOS x AUTOS PROPERTY DAMAGE (Per accident) $ A X UMBRELLA LIAB X OCCUR 0708525 7/1/2018 7/1/2019 EACH OCCURRENCE $5,000.000 _ ^ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION S $ A 'WORKERS COMPENSATION 0708526 7/12018 7/1/2019 PER OTH- STATUTE ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE l l N/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 II yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) City of Oshkosh and its officers,council members,agents,employees and authorized volunteers are 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 REPRESENTATIVE usa Q ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD