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HomeMy WebLinkAboutAnnex 71 LLC 8-18-18 Client#: 31715 ANNEGRO ACORD.,, CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DD/VYYY) s/1o/20D8 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 NAME: Robin Stinger ONI Risk Partners PHONE 9861 706 317- - FAX (A/C,No,Ext): (A/C,No 317-706-9988 600 E 96th St Suite 400 ADDRESS: robin.stinger@onirisk.com Indianapolis, IN 46240 INSURER(S)AFFORDING COVERAGE !MC* INSURER A:TM Onclnnae Insurance Compsn 10677 INSURED INSURER B: Annex 71,LLC INsuRERc: 409 Massachusetts Ave.,Suite 300 INSURER D: Indianapolis,IN 46204 — I 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. I TYPE OF INSURANCE ADDL.SUBR POUCY EFF POUCY EXP L INSR WVD POUCY NUMBER (MMDD/YYYY) (MM/DDIYYYY) ITS A X COMMERCIAL GENERAL UABILITY X X WKG00249000 08/18/2017 08/18/2018 pEAACCHH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR PREMISES(Ea tgunence) $100,000 X $2,500 Ded BI&PD MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000PRO- _ POLICY X JECT X LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: A AUTOMOBILE LIABILITY X X 5135001700 08/18/2017 08/18/2018(CEOaAAaBINEDDSINGLE LIMIT 31,000,00 XI ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) S A X UMBRELLA LIAB OCCUR X 5821085097 08/18/2017 08/18/2018 EACH OCCURRENCE $10,000,000__ EXCESS LIAB X CLAIMS-MADE AGGREGATE $10,000,000 DEO] X RETENTION SO S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR'PARTNER/EXECUTIVE _. - EL EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N/A'. • (Mandatory In NH) E.L DISEASE-EA EMPLOYEE S If yes,describe under 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) RE:Annual Excavation/Work In The Right-of-Way City of Oshkosh,and its officers,council members,agents,employees and authorized volunteers are included as additional insured on General Liability& Auto Liability,when required by written contract. 30 days notice of cancellation(10 days for nonpayment)applies. CERTIFICATE HOLDER CANCELLATION City Of Oshkosh,A Wisconsin SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Municipal Corporation ACCORDANCE WITH THE POLICY PROVISIONS. Redevelopment Auth. of the City of Oshkosh,WI AUTHORIZED REPRESENTATIVE 215 Church Ave., PO Box 1130 Oshkosh.WI 54993-1130 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1639475/M 1437268 R STI N