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HomeMy WebLinkAboutAugust Winter & Sons 10-1-18 _ Page 1 of 1 A`oRD® /DD/ CERTIFICATE OF LIABILITY INSURANCE DATE(MMYYYY) 09/26/2017 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: Willis of Minnesota, Inc. PHONE 1-877-945-7378 FAX 1-888-467-2378 c/o 26 Century Blvd (A/C.No.Extl: .(AIC,NoI. E-MAIL certificates@Willis.com P.O. Box 305191 ADDDREDRE SS: Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAICN INSURER A: Phoenix Insurance Company 25623 INSURED INSURERS: Travelers Indemnity Company of America 25666 August Winter & Sons, Inc. - - - P 0 Box 1896 INSURERC: Travelers Indemnity Company 25658 Appleton, WI 549121896 USA INSURERD: Travelers Casualty Insurance Co. of Americ 19046 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W3662945 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYYI (MMIDDIYYYY) LIMITS X COMMERCIALOENERALLUIBILITY EACH OCCURRENCE $ 2,000,000 MAGE TO CLAIMS-MADE X OCCUR PREM SES(EaENTED occurrence) $ 300,000 A X Contractual Liab. MED EXP(Any one person) $ 10,000 Y DT-CO-6934C377-PHX-17 10/01/2017 10/01/2018 2,000,000 PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY X JECOT- LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: _ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED AUTOS ONLY AUTOS DT-810-323D2093-IND-17 10/01/2017 10/01/2018 BODILY INJURY(Per accident) $ HIRED — NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY (Per accident) $ $ C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 20,000,000 EXCESSLIAB CLAIMS-MADE DTSX-CUP-6934C377-IND-17 10/01/2017 10/01/2018 AGGREGATE $ 20,000,000 DED X RETENTIONS 10,000 $ WORKERS COMPENSATION 'X PER STATUTE EH R AND EMPLOYERS'LIABILITY B ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? n 100,000 NIA DTD-TBB-UB-6934C37-7-17 10/01/2017 10/01/2018 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ _ If yes,describe under 500,ODO DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Workers' Compensation DTN-UB-5580L00-2-17 10/01/2017 10/01/2018 B.L. Each Accident $100,000 i MC - Per Statute E.L. Disease- policy $500,000 E.L. Disease Each Emp$100,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) The City of Oshkosh and its officers, council members, agents, employees and authorized volunteers are named as additional insureds to the Comm'l General Liability per attached Endorsement #CGT808 - Blanket Additional Insured (Contractors), for acts caused by AWS in the performance of their work to which the written contract requiring insurance applies. i l Cik_ CERTIFICATE HOLDER CANCEL TION I ' SHOULD Y OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE E IRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN LE ' ' NNCE WITH THE POLICY PROVISIONS. CITY C Oshkosh, City of AUTHORIZEDREPRESENTATIVE P 0 Box 1130 �i Oshkosh, WI 549021130 �i_' 7 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 15091521 BATCH: 456837