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HomeMy WebLinkAboutAffordable Concrete 4-26-18 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ACORDTM 04/27/2017 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 BOCK INSURANCE AGENCY, INC. NAME:Mark Meyer PHONE FAX 2337 JACKSON ST (A/C,No,Eel),920-235-5737 A/C,No):1-920-235-7227 OSHKOSH, WI. 54901 E-MAIL Phone: 920-235-5737 Fax:920-235-7227 ADDRESS mark.meyINSURER(S)AFFORDING AFFORDING COVERAGE NAIC# 1418,1 INSURER A, ACUITY INSURED INSURER B. AFFORDABLE CONCRETE INSURER C. 225 W HURON ST INSURER D. OMRO WI 54963 INSURERE: ,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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD wvD POLICY NUMBER (MM(DDIYYYY) (MM/DD/YYYY) LIMITS -A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑OCCUR DAMAGE TO RENTED PREMISES(Ea occurence) $100,000 X Bis-Pak Business Liability and Medical A MED EXP(Any one person) $5,000 Expenses CBL58398 04/26/2017 04/26/2018 PERSONAL 8 ADV INJURY Included GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 POLICY ❑PRO_ JECT ❑LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ X (Ea accident) ANY AUTO - BODILY INJURY(Per person) $250,000 OWNED AUTOS SCHEDULED ONLY AUTOS A BODILY INJURY(Per accident) $500,000 X HIRED AUTOS X NON-OWNED CAL58398 04/26/2017 04/26/2018 PROPERTY DAMAGE ONLY AUTOS ONLY (Per accident) $100,000 - UMBRELLA LIAB - OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND PER OTHER EMPLOYERS'LIABILITY 'ONSTATUTE ANY PROPRIETOR/PARTNER/ ❑ N/A 'i E.L.EACH ACCIDENT $ EXECUTIVE OFFICER! MEMBER EXCLUDED? I E.L.DISEASE-EA EMPLOYEE $ II yes,describe under DESCRIPTION OF OPERATIONS below 1 E.L.DISEASE-POLICY LIMIT $ $ $ $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES 30 day notice of cancelation has been added to contract 4/26/2017 CERTIFICATE HOLDER CANCELLATION City of Oshkosh SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 215 Church St. DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY Oshkosh, WI. 54901 PROVISIONS. UTHO ED R RESENTATIVE 4�\ f ©1988-2015 ACORD CORPORATION. All ri h yI ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD APR S 8 zu I CL-517(3-16) __ CE. 1