HomeMy WebLinkAboutBG Durite Concrete Inc 7-1-18 AW o DATE{MM/DDlYYY1�CERTIFICATE OF LIABILITY INSURANCE 5/22/2018
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 CONTNAME: Kelly T--
RADTKE RHONE INSURANCE PHON N,.E,qi; (920)982-3048 FAX
,No: (920)982-2584
PO Box 210 E-MAADDRESS: radtkerhoneCa)radtkerhone.com
New London,WI 54961-0210 INSURERS)AFFORDING COVERAGE MAIC tf
INSURER A: Society Insurance
INSURED INSURER B:
BG Durite Concrete INC
INSURER C:
INSURER D:
220 Industrial Park Ave INSURER E:
HORTONVILLE,WI 54944 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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 St1BR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE ii so wvo POLICY NUMBER (MMIODIYYYY) (MMIDDIYYYY) LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE X OCCUR DAMAGE TO—RENTED
PREMISES(Ea occurrence) $
MED EXP(Any one person) S 5,000
A BP17018549 7/1/2017 7/1/2018 PERSONAL tLADVINJURY $
GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000
RO-
POLICY JECr I LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER:
AUTOMOBILE LIABILITY (C.OMEa BIBIINNEDD SINGLE LIMIT $ 1,000,000
ANY AUTO BODILY INJURY(Per person) $
A AUTOS ONLY �XSCHEDULED CA17018551 7/1/2017 7/1/2018 BODILY INJURY(Per accident) $
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY (Per accident)
_
X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000.000
A EXCESS UAB CLAIMS-MADE UM170185570 7/1/2017 7/1/2018 AGGREGATE s _
DEO RETENTION $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS LIABILITY ,,/N STATUTE i ER
ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ 100,000
A OFFICER/MEMBER EXCLUDED? N 1 A WC17018550 7/1/2017 7/1/2018
(Mandatory In NH) EL DISFaRF-EA EMPLOYEE $ 100,000
Myer describe fader
DESCRIPTION OF OPERATIONS below El.DIRFASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,AddIUonal Remarks Schedule,may be attached if more apace la required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
215 Church Ave ACCORDANCE WITH THE POLICY PRO
Oshkosh,WI 54903 A oR¢EDTtEPRESENTA11V
®19 - 15 C C RATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered ma of ACORD