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HomeMy WebLinkAboutAtomic Plumbing & Heating Inc 4-29-18 �...,,,111 ATOMPLU-02 SMOHAN ACORE) DATE(MM/DD/YYYY) 1`----- CERTIFICATE OF LIABILITY INSURANCE 4/12/2017 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 NAME CT Sandra R.Mohan,CIC, PWCAM Johnson Insurance Northeast PHONE 920 445-7451 FAX 877 254-8586 318 South Washington Street E-MAIL o,Exg:� (NC,No): Green Bay,WI 54301 ADDREss:smohan@johnsonins.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Integrity Mutual Insurance 14303 INSURED INSURER B: Atomic Plumbing&Heating Inc INSURERC: PO Box 388 INSURERD: Ripon,WI 54971 INSURERE: _ 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. ILTR TYPE OF INSURANCE IANSO WVD POLICY NUMBER 1(MM D//LICYYYYYFF)) (MM/DD//YYYY)/ LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CT 2646247 RNTED 04/29/2017 04/29/2018 PR—DRE�S(EaEoccurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: EBL AGGREGATE $ 3,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 I (Ea accident) A X I ANY AUTO CA 2646248 04/29/2017 04/29/2018 BODILY INJURY(Per person) $ _ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS AUTOS NON-OWNED I (Per accident) $ X UMBRELLA UAB X OCCUR ( EACH OCCURRENCE $ 2,000,000 A EXCESS UAB CLAIMS-MADE CUP2646250 04/29/2017 04/29/2018 AGGREGATE $ 2,000,000 DED RETENTION$ $ WORKERS COMPENSATION I X STATUTE 1 1 ERH AND EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N NfA WCP2646249 04/29/2017 04/29/2018 '.E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) i E.L.DISEASE_-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ 500,000 A Commercial General L CT 2646247 04/29/2016 04/29/2017 Per Claim 100,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) I RECEIVED APR 21 2017 CITY CLERK'S OFFICE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Oshkosh City Clerks Office ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Avenue Oshkosh,WI 54903-1130 AUTHORIZED REPRESENTATIVE 1,:______)# ----- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD