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HomeMy WebLinkAboutBastian Construction LLC 5-1-18 �. ...0 BASTCON-01 CPETERSON '4 05/ CERTIFICATE OF LIABILITY INSURANCE DATE041 0 1 7 ) 5l 0412017 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: Truyman Haase Zahn Ins Group PHONE 420 E.Northland Avenue lac,No,Ext):(920)730-0123 I FAX (A/C.No):(920)730-9403 Appleton,WI 54911 E-MAIL .ADDRES.5; -- INSURER(S)AFFORDING COVERAGE NAIC C INSURER A:Frankenmuth Mutual INSURED INSURER B: Bastian Construction LLC INSURER C: 8309 Steeple Hill Dr INSURER D: Larsen,WI 54947-9538 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 TYPE OF INSURANCE ADDL SUBRI POLICY NUMBER POLICY EFF I POUCY EXP LTR INSD yNlZ IMM/DDN TYI I(MM/DD/YYYY) UMITS A X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,000 i CLAIMS-MADE T( OCCUR BOP6152067 05/01/2017I 05/01/2018 RataEEL(EiroNnrPencel S 500,000 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 2,000,000 GEN'L AGGREGATE LIMIT APPLIESPER: I GENERAL AGGREGATE $ X POLICY ;pa I LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: _ 4 S A AUTOMOBILE LIABILITY (CEO BIINEDaccidentSINGLE LIMIT $ 1,000,000 X ANY AUTO j BA 6152067 05/01/2017 05/01/2018 BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON WNED I 1 PROPERTY DAMAGE AUTOS ONLY AUTO ONLY (Per accident) $ $ A X UMBRELLA LAB ' X i OCCUR EACH OCCURRENCE S 2'000'000 EXCESS LIAB CLAIMS-MADE BOP6152067 05/01/2017.05/01/2018 AGGREGATE 5 2,000,000 DED X RETENTIONS 10,000 S A WORKERS COMPENSATION X PER I OTH- AND EMPLOYERS LABILITY Y/N STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE WC 6152067 05/01/2016 05/D1/2017 EL EACH ACCIDENT S 100,000 QFFICER/MEMEER EXCLUDED? N/A (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT j DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) [ AY 08 2017 r•,T .,. ,t 't?',:;"S OFFICE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Oshkosh ACCORDANCE WITH DATE THEPOLICYREOF PROVISIONS.NOTICE WILL BE DELIVERED IN 215 Church Ave PO Box 1130 Oshkosh,WI 54901 AUTHORIZED REPRESENTATIVE T , f. 46 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD