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HomeMy WebLinkAboutAl Dix Concrete 3-1-18 A ® DATE(MM/DD YYYY) CERTIFICATE OF LIABILITY INSURANCE 1/12/2018 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 Mary McLennan Spectrum Insurance Group GB PHONE FAX 303 Packerland Dr., Ste C (A/C.No.Eat):920-884-2850 (A/C,No):920-884-2851 Green Bay WI 54307 ADDRESS: Mary.McLennan©spectruminsgroup.com INSURERS)AFFORDING COVERAGE NAIC N INSURER A:Sentry Insurance _ INSURED ALDIX-1 INSURER B: Al Dix Concrete, Inc. 500 Draper Street INSURERC: Kaukauna WI 54130 INSURERD: _ INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1481542484 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 ADDLINSD SUBRWVD POLICY NUMBER (MMIDDYIYYYY) (MM LICY EXP LTR /DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY A0078052004 3/1/2017 3/1/2018 EACH OCCURRENCE $1,000,000 DAMAGE CLAIMS-MADE X OCCUR PREMISESO(EaENTEoccu ence) $500,000 MED EXP(Any one person) 510,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY X T X LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER $ A AUTOMOBILE LIABILITY A0078052001 3/12017 3/1/2018 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 PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) A X UMBRELLA LIAB X OCCUR A0078052006 3/1/2017 3/12018 EACH OCCURRENCE $3,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 _ DED X RETENTION$❑ $ A WORKERS COMPENSATION A0078052005 3/1/2017 3/12018 X STATUTE I ERH AND EMPLOYERS'LIABILITY - ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $100.000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500.000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Oshkosh,its officers,council members,agents,employees or authorized volunteers are included as Additional Insured on a primary and non-contributory basis with a 30 day notice of cancellation subject to insurance laws for the State of Wisconsin CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Oshkosh 215 Church Ave Oshkosh WI 54903-1130 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD