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HomeMy WebLinkAboutAG Excavating 4-13-18 —__.....4 AGEXC-1 OP ID:WF ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDWYYYY) �� 03/28/2017 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 Dickenshied Cravillion NAME: Debra J.Verstegen — Insurance Services,Inc. __WC,No,Extl;920-336-1312 FAX No), 920-339-2422 PO Box 5550 E-MAIL De Pere,WI 54115-5550 ADDRESS: Debra J.Verstegen INSURER(SLAFFORDING COVERAGE I NAIC e _ INSURER A:Erie Insurance Group INSURED AG Excavating INSURERS AI Gossen 1336 Russett Ct INSURER C: Green Bay,WI 54313 INSURER 0: INSURER E: _INSURERF: 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 TYPE OF INSURANCE—__----- AODL3UBR' - POUCY NUMBER -- - POLICY EFF—-POLICY OYEXP LIMITS LW INSD'MD (MMIDOM/YY) (MMNplYYYYI A X -COMMERCIAL GENERAL U9ILIT AY I #EACH OCCURRENCE I$ _ 1,000,000P CLAIMS-MADE ILX OCCUR IQ40.1350637 04/13/2017 04/13/2018 DAMAGE TD RENTED PRENISES,Ea oowr,ante) S 100,000 1 MED EXP(Any one person) .s 10,000 _._ l PERSDNAL S ADV INJURY S 1,000,000 GEN L AGGREGATE LIMIT APPUES PER: I GENERAL AGGREGATE ;S 3,000,000 POLICY WI: I LOC —PRODUCTS-COMP/OPAGG s 3,000,000 OTHER: I I$ AUTOMOBILE LIABILITY j COMBINED SINGLE LIMIT $ 1,000,000 ((Ea 8oddem)— _ A X ANY AUTO Q04-1340048 04/13/2017 04/13/2018 LBODILY INJURY(Per person) $ AUTOSLL OWNED SCHEDU� I BODILY INJURY(Per accident)I$ --- X HIRED AUTOS .X--_.I NON-AUTOS O ED !PROPERTY DAMAGE (Per accident) s -.- — S ' X UMBRELLA LIAB X OCCUR I EACH OCCURRENCE 'S 2,000,000 A ' ' EXCESS UAB CLAIMS-MADE ,Q28-1370234 04/13/2017 04/13/2018'AGGREGATE $ 2,000,000 DED X RETENTION 3— 0 $ WORKERS COMPENSATION I PEP,TUTE I ER OTH- I AND EMPLOYERS'LIABIUTY X I STA _ A i-NY PROPRIETOR/PARTNER/EXECUTIVE Y r N !Q88-1300640 04/13/2017 04/13/2018 E.L EACH ACCIDENT S 500,000 OFF.CER/MEMBER EXCLUDED' NIA ------------- (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE$ 500,000 ryes.descnbe under ----- ---- DESCRIPTION CF OPERATIONS belv.v I E L.DISEASE•POLICY LIMIT $ 500,001 A Inland Marine Q40-1350637 1 04/13/2017 04/13/2018 DESCRIPTION OF OPERATIONS r LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) RECE__. 1 V ED LUN1220177 CITY CI.FRWS OFFICE CERTIFICATE HOLDER CANCELLATION CITYO01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof OshkoshTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Ave PO Box 1130 AUTHORIZED REPRESENTATIVE Oshkosh,WI 54903 Debra J.Verstegen ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD