Loading...
HomeMy WebLinkAboutBoldt Company 1-1-18 �...4,11 BOLDCOM-01 KATR ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 4....----- 12/19/2016 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 NTA (920)968-5217 NAME:CT Trisha Kasper Willis of Minnesota,Inc. PHONE FAX P.O.Box 877 (A/c.No.Ext):920-968-5217 (A/C,No): ADDRESS:E-M trisha.kas r (Ilistowerswatson.com Appleton,WI 54912-0419 � INSURER(S)AFFORDING COVERAGE NAIC II INSURER A:The Travelers Indemnity Company INSURED The Boldt Company INSURER B:Travelers Indemnity Company of Connecticu 40282 P 0 Box 419 INSURER C:Travelers Property Casualty Company of Am Appleton,WI 54912-0419 INSURERD: 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 POLICY EXP LIMITS LTR INSR MD POLICY NUMBER (MM/DDIYYYY) /Y(MMIDDYYY) GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 A X COMMERCIAL GENERAL LIABILITY VTC2K-CO-3992B816-IND-17 1/1/2017 1/1/2018 DAMAGETORENTED 500,000 _ PREMISES(Ea occurrence) $ CLAIMS-MADE I Xl OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 5,000,000 GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE UMIT APPUES PER PRODUCTS-COMP/OP AGG $ 5,000,000 POLICY X PRO-JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE UMIT 2,000,000 (Ea accident) $ B X ANY AUTO VTE-CAP-3510A098-TCT-17 1/1/2017 1/1/2018 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ X HIIREDS AUTOS — AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS (PER ACCIDENT) $ UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 10,000,000 C X EXCESS UAB CLAIMS-MADE VTFSJ-EX-9497L897-TIL-17 1/1/2017 1/1/2018 AGGREGATE $ 10,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION X WORYLIATUS OH- AND EMPLOYERS'LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE Ya VTC2J-UB-4688B552-17 1/1/2017 1/1/2018 E.L EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? N N/A (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ 1,000,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C lExcess Worker's Compensation VTWXJ-UB-3512A762-17 1/1/2017 1/1/2018 Wisconsin $500,000 Retention C Excess Worker's Compensation�� VTWXJ-UB-4986B487.17 1/1/2017 1/1/2018 Oklahoma $500,000 Retention DESCRIPTION F OPER.A ION!l ETIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) See attache p ge. JAN 0 2 CITY CLER, , CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Oshkosh, City of THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 Church Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Oshkosh,WI 54901- AUTHORIZED REPRESENTATIVE rr ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD