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HomeMy WebLinkAboutAdvance Construction 06-18-18 l ® DATE(MM/DD/YYYY) AC RD CERTIFICATE OF LIABILITY INSURANCE l0/6/2017 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 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 Lisa VonRueden NAME: R&R Insurance Services Inc (a/c No.ExD: (262)953-7210 1 UNC NoB:(262)953-1311 1581 E Racine Avenue EMAIL ADDRESS:lisa.vonrueden@rrins.com PO Box 1610 INSURERS)AFFORDING COVERAGE _— NAIC 8 Waukesha WI 53187-1610 INSURER A:Sentry Insurance _ 24988 INSURED INSURER B: Advance Construction Inc INSURERC: 2141 Woodale Ave INSURERD: INSURER E: Green Bay WI 54313 INSURER F: COVERAGES CERTIFICATE NUMBER:17/18 Liab 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 SUBR POLICY EFF POLICY EXP OMITS LTR INSR WVD POLICY NUMBER IMM(DDIYYYYI IMM/DQIYYYY1 X COMMERCIAL GENERAL LIABILITY A00040142 6/18/2017 6/18/2018 EACH OCCURRENCE $ 1,000,000 AGE TO A CLAIMS-MADE i X OCCUR PREMISES SES EaENTED occurrence} $ 500,000 X C07021 Bkt Ongoing/PNC MED EXP(Any one person) $ 5,000 CO2010 Bkt Ongoing PERSONAL&ADVINJURY $ 1,000,000 GENt AGGREGATE LIMIT APPLIES PER CO2037 Bkt Completed ops GENERAL AGGREGATE $ 3,000,000 POLICY X JPECOT- LOC C00001 Bkt Waiver PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY A0040142 6/18/2017 6/18/2018 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO CA7601 Bkt AI/PNC BODILY INJURY(Per person) $ ALL OWNED SCHEDULED C112404 Bkt Waiver BODILY INJURY(Per accident) $ _ AUTOS NON PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS UTO-0 (Per accident) X HPD 100 Comp X HPD 500 Coll Medical payments $ 10,000 X UMBRELLALIAB X OCCUR A0040142 6/18/2017 6/18/2018 EACH OCCURRENCE $ 10,000 000 A EXCESS UAB CLAIMS-MADE ED7091 Bkt AI/PNC AGGREGATE S 10,000,000 DED X RETENTIONS 10,000 EU7000 Bkt Waiver $ WORKERS COMPENSATION PER OTH- 1 AND EMPLOYERS'LIABILITY X STATUTE ER YIN ANY PROPRIETOR/PARTNERfFXECUTNE NIA A E.L.EACH ACCIDENT $ 1,000,000 A 1(Mandatory In HR EXCLUDED? N A0040142 006 6/18/2017 6/18/2018 E.L.DISEASE-EA EMPLOYEES 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Leased/Rented Equipment A0040142 6/18/2017 6/18/2018 400,000 Limit of Insurance 500 Deduct Installation Coverage 600,000 Lint of insurance 500 Deduct DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) RE: Annual Excavation/Work in the Right-of-Way. City of Oshkosh is Additional Insured regarding General Liability per the above referenced form. 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 215 Church Ave ACCORDANCE WITH THE POLICY PROVISIONS. Oshkosh, WI 54903 AUTHORIZED REPRESENTATIVE Brad Stehno/LV427 __�- -- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 on,.:nn