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HomeMy WebLinkAboutBP Baker Construction Inc 6-24-18 BPBAKER-01 SCLARK AC RO DATE(MM/DD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 01130/2018 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 CO NTT CT Shelly Clark - Richards Insurance of Oshkosh,LLC PO Box 2424 A/C,,,PHONE,E:tl:(920)235-1980 1 (A/C,No):(920)235-1982 48 North Oakwood Road ADDRESS:sclark@richardsinsurance.com Oshkosh,WI 54903 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:SeCUra Insurance -_ 22543 INSURED INSURER B: B P Baker Construction Inc INSURER C: ATTN Brian Baker - 5524 Zoar Rd INSURER D: Pickett,WI 54964-9586 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY1 tMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR TC3165509 06/24/2017 06/24/2018 DAMAGES(RENTED 100,000 X PREMISES(Ea occurrence) $ X BP0450 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY izef LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ COMBINED A AUTOMOBILE LIABILITY Ea accident SINGLE LIMIT) $ 1,000,000 X ANY AUTO X A3165510 06/24/2017 06/24/2018 BODILY INJURY(Per person) $ OWNED X SCHEDULED _ AUTOS ONLY AUTOppSyyry BODILY INJURY(Per accident) $ X AUTOS ONLY X AUTOS ONL� PROPERTY acEcidentDAMAGE $ $ A X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS UAB CLAIMS-MADE CU3181180 06/24/2017 06/24/2018 AGGREGATE $ 1,000,000 DED RETENTION$ $ A WORKERS COMPENSATION STATUTEPER ERH AND EMPLOYERS'LIABILITY WC3165511 06/24/2017 06/24/2018 100,000 ANYY IPRPROPRIETOR/PARTNER/EXECUTIVE Y/N N/A E.L.EACH ACCIDENT $ OF(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CITY OF OSHKOSH,AND ITS OFFICERS,COUNCIL MEMBERS,AGENTS,EMPLOYEES,AND AUTHORIZED VOLUN E SHALL BE DDIT L INSUREDS ON GENERAL LIABILITY AND BUSINESS AUTOMOBILE COVERAGE PER ENDORSEMENT BP 0450 Li FEB 0 6 2018 CITY C CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TY OF OSHKOSH THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CI ATTN CITY CLERK ACCORDANCE WITH THE POLICY PROVISIONS. 215 CHURCH AVE OSHKOSH,WI 54 901-4 747 AUTHORIZED REPRESENTATIVE TI � ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD