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HomeMy WebLinkAboutABT Foundation Solutions 3-27-18 ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 5/23/2017 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 Starr Insurance NAME: Ryan Jones PHONE 5005 W. Loomis Rd. (A/C.Nrt Fxt)•414-421-3800 IA/C.Not:414-421-6145 Greenfield WI 53220 E-MAIL ADDRESS: rou info start9 P•com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Western National Mutual 115377 INSURED ABTFO-1 INSURER B ABT Foundation Solutions, Inc. 8718 Hwy 76 INSURER C Neenah WI 54956 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1696070143 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 AUUL SUB POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVDD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CPP1022567 3/27/2017 3/27/2018 EACH OCCURRENCE $1,000,000 1 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X GENERAL AGGREGATE $2,000,000 PRO- JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY CPP1022565 3/27/2017 3/27/2018 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $1,000,000 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ (Per accident) $ A X UMBRELLA LIAB X OCCUR UMB1003576 3/27/2017 3/27/2018 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 DOD X RETENTION$10,000 A WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY WCV1002731 3/27/2017 3/27/2018 X PER DTH- Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE R/EXECUTIVE E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $100,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may he attached if more space is required) The City of Oshkosh, and its officers, council members, agents, employees, and authorized volunteers are hereby listed as additional insureds on the General Liability and Auto policies as respects work performed by the named insured when required by written contra, in accordance with policy terms&conditions. A 30 day notice of cancellation endorsement has been requested of thelinsurfnce ccarriel%ED r I MAY 31 2017 CERTIFICATE HOLDER CANCELLATION CITY'CLEi-. ._,t9rtlt.E. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. Box 1130 ACCORDANCE WITH THE POLICY PROVISIONS. Oshkosh WI 54903-1130 AUTHORIZED REPRESENTATIVE (PaiSielf4A-- ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD