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HomeMy WebLinkAboutAnderson Brothers 1-1-18 ANDEBRO-01 MWOLF ACORO. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/19/2017 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 NAME: The Diedrich Agency PHONE 222 Blackburn St (A/C,No,Eat):(920)748-2811 I FAX No):(920)748-5044 Ripon,WI 54971 E-MAILDRESS: INSURER(S)AFFORDING COVERAGE NAIL/ INSURER A:Society Insurance _ 15261 INSURED INSURER B: Anderson Brothers,Inc INSURER C: 2708 Harrison St INSURERD: Oshkosh,WI 54901 — 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE ,INSO WVD POLICY NUMBER IMM/DDNYTY1 IMM/DDIYYYY1 UNITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR BP15038809 01/01/2017 01/01/2018 DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10'000 PERSONAL S,ADVINJURY $ 1r000,000 GEN'L AGGREGATE LIMIT APP_LIESPER GENERAL AGGREGATE $ 2,000,000 POLICY JECT l — LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER • A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ ANY AUTO CA15038810 01/01/2017 01/01/2018 BODILY INJURY(Per person) $ OWNED X SCHEDULED AUTOSIRE ONLY AUTOOSyyry BODILY INJURY(Per accident) $ X AUTOS ONLY X NON-OWNED UTOS ON D { ? Id QAMAGE , ! $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS11- X D EMPLOYERS'UASILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE f WC15038811 01/01/2017 01/01/2018 500,000 Fgl MEMBER EXCLUDED? N N f A E.L.EACH ACCIDENT $ andatory In NH) - E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,descnbe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) RECEIVED JUN 19 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. 215 Chruch Street Oshkosh,WI 54901 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD