Loading...
HomeMy WebLinkAboutBroadbank Solutions Inc 7-1-18 _____,,„11 BROASOL-01 PSMITS AcoRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD(YYYY) �� 6/6/2017 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 mom' Susan Lambert,WISC,AAI,AIS,ACSR,PWCAM Johnson Insurance Northeast PHONE 920 445-7418 FAX 877 254$586 318 South Washington Street (A/C,No,Ext):( ) (A/gNo): Green Bay,WI 54301 ADDRE slambert@nj,ohnsonins.com ADDRESS:slambert@johnsonins.com AFFORDING COVERAGE NAIC 0 INSURER A:Sentry Insurance 24988 INSURED INSURER B: Broadband Solutions Inc INSURERC: 1886 Commerce Drive INSURER D: DePere,WI 54115 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/YYYY) (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 1 CLAIMS-MADE X OCCUR X A0063937004 07/01/2017 07/01/2018 DAEMISES MAGE RENTEDaoccurre rice) S 500,000 PRTO(E MED EXP(Any one person) S 10,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 3,000,000 POLICY X J& LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: S AUTOMOBILE UABILITY COMBINED SINGLE LIMIT S 1,000,000 (Ea accident) A X ANY AUTO A0063937001 07/01/2017 07/01/2018 BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS _ NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS (Per accident) S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 10,000,000 ~ `A EXCESSUAB CLAIMS-MADE A0063937006 07/01/2017 07/01/2018 AGGREGATE S 10,000,000 DED X RETENTIONS 10,000 S WORKERS COMPENSATION X ;MUTE EMPLOYERS'LIABILITY STATUTE ER YIN A ANY PROPRIETOR/PARTNER/EXECUTIVE A0063937005 07/01/2017 07/01/2018 E.L.EACH ACCIDENT S 500,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Oshkosh,and its officers,council members,agents,employees and authorized volunteers are included as an Addition licy Forms,Conditions and Exclusions. RECEIVE- LAM 072017 CTTY CL.ERK'S OFF'1C� CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CityACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Ave Oshkosh,WI 54903 AUTHORIZED REPRESENTATIVE 1;24A.S--'Cleo . ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD