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HomeMy WebLinkAboutAmerican Pavement Solutions 4-8-18111, / 1 ® DATE(MM/DD/YYYY) AWRD CERTIFICATE OF LIABILITY INSURANCE 6/2/2017 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 HNI Risk Services of Wisconsin PHONE NAME` PO Box 510187 (A/C,A L,Ext): 262-782-3940 FAX No): 262-782-4198 E ADDRESS: certsAhni.com New Berlin WI 53151 INSURER(S)AFFORDING COVERAGE NAIC o INSURER A: Cincinnati Insurance Company A+ INSURED American Pavement Solutions Inc. INSURER B: West Bend Mutual Insurance Company THSMA, Inc. INSURER C: CNA Insurance Company/Columbia Casualty Daffinson Transport, LLC INSURERD: PO Box 13007 INSURER E: Green Bay WI 54307-3007 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 ADULTYPE OF INSURANCE INSR ENDSUM POLICY NUMBER MM/DD/YYYY MM/DDPOLICY EFF Y/YYYY LIMITS EXP LTR INSR WVD ( ) ( ) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY EPP03227 42 4/08/17 4/08/18 PREMISES EaEoccu ence) $ 500,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X jEt° LOG $ COMINED AUTOMOBILE LIABILITY (Ea accidentSINGLE LIMI I $ 1,000,000 A EBA03227 42 4/08/17 4/08/18 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) $ A X UMBRELLA LIAB X OCCUR EPP03227 42 4/08/17 4/08/18 EACH OCCURRENCE S 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE S 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION X I WC ORST LIMITS I I0T H- B AND EMPLOYERS'LIABILITY YIN JEV 1727244-06 4/08/17 4/08/18 ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICE/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500000 —. If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 npgr-RiwrinN CIF r1PFRATIr1NS hrinw A Equipment Floater EPP03227 42 4/08/17 4/08/18 Rented/Leased Equip 75,000 C Pollution Liability C6024313193 4/26/17 4/26/18 Occurrence/Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) R1ECE*"�;+TLE/ City of Oshkosh,its officers,council members,agents,employees or a y authorized volunteers are additional insured regarding general liability JUN 0 5 2017 including ongoing and completed operations on a primary and noncontributory basis. CITY CLERK'S OFFICE CERTIFICATE HOLDER CANCELLATION Oshkosh Corporation and its subsidiaries SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2307 Oregon Street AUTHORIZED REPRESENTATIVE Oshkosh WI 54904 Q ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD