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HomeMy WebLinkAboutBruce Davis Construction 1-29-18 ti,) ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDOR'YYY) �/. 5/12/2017 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 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 CONTNAMEACT ANN HUBBELL ANN HUBBELL PHONE 262-542-4093 1 FAx 262-542-2523 E MAIL ..EXU pvc.N?I:.. RURAL MUTUAL INSURANCE AHUBBELL@RURAUNS.COM ADDREsaS; 2417 SILVERNAIL ROAD INsuRER(s)AFFORDING MARACA roue r PEWAUKEE,WI 53072 INSURER A; RURAL MUTUAL INSURANCE INSURED INSURER B BRUCE DAVIS CONSTRUCTION,LLC INSURER C: 4695 CATHERINE COURT INSURER D: BROOKFIELD,WI 53072 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. LTR TYPE OF INSURANCE ADOLSUBR--� _-- _. -- I POLICY EFF POLICY EXP - _ ---- '1NSD'WWIW POLICY NUMBER 'jMMJDOlYYWI IMMIDDfWYY)i UNITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE '$ 1,000,000 {�' OAMAGE TO RENTED ..... .........---_.._ I CLAMS-MADE L OCCUR t PREMISE$Ma odCVrrelH:e! $ 100,000 MED EXP(Any one person) $ 5,000 A Y 8OPG089740 01/29l2017 01/29/2018 PERSONAL E AOV INJURY $ 1,000,000 GENIC AGGREGATE LIMIT APPLIES PER: —_� GENERAL AG REGATE $ 2,000,000 POLICY j X!JPERa „..,._..j LOC ...__ X OTHER: BUS.OWNERS PAK I PRODUCTS-COMP OP AGG 1$ 2,000,000 AUTOMOBILE LIABILITY I !COMBINED SINGLE LIMIT $IE.,accident) 1,000,000 ANY AUTO _ 1 BODILY INJURY(Per person) $ OWNED SCHEDUL=D ......... ......_._ __ A X_ AUTOS ONLY AUTOS BAPG089749 01/29/2017 01/291201$ BODILY INJURY(Per accident) $ HIRED :.NON-OWNED , I _. .. ..... " AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ I X UMBRELLA LIAR OCCUR I EACH OCCURRENCE $ 1.000,000 A , t EXCESSLIAB iCLAIMS-MADE BOPG089740 01/29/2017`01/29/2018 i AGGREGATE $ , 'DED ' .RETENTION$ I 1 _ I I WORKERS COMPENSATION I I`(I PER [ OTH- AND EMPLOYERS'LIABILITY YIN „]STATUTE : LER_i. _. ...... ANYPROPRIETORIPARTNER/EXECUTIVE WRKG089756 01/29/2017 Q1/29/201$ EL EACH ACCIDENT $ 500,000 A (OFFICER/MEMBER EXCLUDED? N NIA (Mandatory in NH) ft s,describe under i E L DISEASE EA EMPLOYE$ 500,000 D Sf,RIPTION OF OPERATIONS below t 1 E.L.DISEASE POLICY LIMIT $ 500,000 i i DESCRIPTION OF OPERATIONS/LOCATIONS f VEHICLES(ACORD 101.Additional Remarks Schedule.may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF OSHKOSH ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE OSHKOSH (n/) ANN HUBBELL I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD