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HomeMy WebLinkAboutAll Star Cutting & Coring 9-16-18 �•� ALLSTAR-02 MTHOMAS ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDYYYY) 12/21/2017 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 250EACT Sandra R.Mohan,CIC, PWCAM Johnson Insurance Northeast PHONE FAX 318 South Washington Street (AIC,No,Ext):(920)445-7451 I(AIC,No):(877)254-8586 Green Bay,WI 54301 Miss;smohan@johnsonins.com INSURER(S)AFFORDING COVERAGE NAIC/ INSURERA:Integrity Mutual Insurance 14303 INSURED INSURER B: ALL STAR Cutting&Coring,LLC INSURERC: W2223 Gentry Dr INSURERD: Kaukauna,WI 54130 INSURER E: 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP UMITS LTR INSD WVD IMM/DD/YYYY) (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 1 CLAIMS-MADE X OCCUR CPP2719474 09/16/2017 09/16/2018 DAMMGETORENTED 100,000 PREMISES IEa owurrencel $ MED EXP(My one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X, FR& LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) S X ANY AUTO CA 2719475 09/16/2017 09/16/2018 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSRE ONLY AUTOS BODILY BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS ONLYD fpencERTY DAMAGE er accident) A X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE iCUP2719477 09/16/2017 09/16/2018 AGGREGATE $ 2,000,000 DED X RETENTION$ 0 Person&Adv $ 2,000,000 A AND EMPLOYERS'LIABILITYIIO X PER X ER WCP2719476 09/16/2017 09/16/2018 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ MFICER/M MBER EXCLUDED? co NIA andatory n I ) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) RECEIVED DEC28 2017 CITY CLERK'S OFFICE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: City Clerk 215 Church Avenue P.O. Box 1130 AUTHORIZED ZZED,REPRESENTATIVE Oshkosh,WI 54903-1130 41) 1 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD