HomeMy WebLinkAboutBerndt Excavating 1-1-18 AW CERTIFICATE OF LIABILITY INSURANCE DATDIYYYY)
01/10/2017
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 CONTACT..
NAME: (Im Mitchell
MITCHELL INSURANCE AGENCY PHONE FAX
(A/C.No.Eat):920-933-0272 (A/C,No):920-233-2712
1924 S.WASHBURN ST. E-MAIL
ADDRESS:iimI mitchellinsurance.org
OSHKOSH,WI. 54904 PROS
CUSTOMER ID N: _.
INSURER(S)AFFORDING COVERAGE NAIC H
INSURED INSURER A:WILSON MUTUAL INSURANCE COMPANY
BERNDT EXCAVATING
INSURER B:
1264 COUNTY RD FF
INSURER C:
OSHKOSH,WI. 54904
INSURER D:
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 SUER! POLICY EFF I POLICY EXP LIMITS
LTRINSR VWD POLICY NUMBER (MM/DD/YYYYI (MM/DD/YYYYI
A GENERAL LIABILITY 01/01/2017 01/01/2018 EACH OCCURRENCE $ _
3200908690 DAMAGE TO RENTED �'000'000
X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 5Q 00ft..
CLAIMS-MADE X OCCUR MED EXP(My one person) $ 5 000
PERSONAL BADVINJURY $ 1.000,000
GENERAL AGGREGATE $ 2,000,000
GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2.000.000_,
POLICY JPERCOT- n LOC $
A AUTOMOBILE LIABILITY 3200908890 01/01/2017 01/01/2018 COMBINED SINGLE LIMIT
(Ea accident) 1,000,000
X ANY AUTO BODILY INJURY(Per person) $
ALL OWNED AUTOS BODILY INJURY(Per accident) $
SCHEDULED AUTOS
PROPERTY DAMAGE
HIRED AUTOS (Per accident)
NON-OWNED AUTOS $
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE 7[ AGGREGATE $
DEDUCTIBLE f $
RETENTION $ •WORKER $
A AND EMPLO COMPENSATION RSIABITY Y1 N 3200908690 01/01/2017 01/01/2018 x TORY LIMITS I'U- ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100.000
OFFICER/MEMBER EXCLUDED? N/A --
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000
If yes,describe under
SPFOIAI PROVISIONS haluw E L.DISEASE-POLICY LIMB $ 500 000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required)
CERTIFICATE HOLDER CANCELLATION
CITY OF OSHKOSH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
215 CHURCH AVE. POLICY PROVISIONS.
OSHKOSH,WI. 54901 AUTHORIZED REPRESENTATIVE
•/ •
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ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD ��