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HomeMy WebLinkAboutCardinal Construction Co 10-1-18 • CARDCONOPC PDEANOVICH ACORD Dl DATE(MM/DYYYY) CERTIFICATE OF LIABILITY INSURANCE 05/21/2018 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 NAME: CONTACT Pamela Deanovich,CISR Jackson Kahl Insurance Services,LLC 17 N Pioneer Road PHONE (NC, ,E>tt):(920)923-40201112 jaC,No):(866)218-6850 Fond Du Lac,WI 54935 E-MAILDRESS:Pdeanovich@jacksonkahl.com INSURERS)AFFORDING COVERAGE NAIC N INSURER A:West Bend Mutual Insurance Co. 15350 INSURED INSURER B: _ Cardinal Construction Co.,Inc. INSURER C: Todd Cardinal - PO Box 564 INSURERD: Fond du Lac,WI 54936-0564 INSURERE: _ 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 VVITH 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 IMM/DD/YYYY1 IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 1360582 10/01/2017 10/01/2018 DAMAGE TO RENTED 200,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: PROPERTY DAMAGE $ 2,500 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO 1360582 10/01/2017 10/01/2018 BODILY INJURY(Per person) $ OWNED�O�S ONLY SCHEDULED O{{DULED BODILYO INJURY(Per accident) $ X AUTOS ONLY X AUOTOS ONLDY ((Per accident)AMAGE $ _ A X UMBRELLA LIAB X OCCUR _EACH OCCURRENCE $ 6,000,000 EXCESS LIAB CLAIMS-MADE 1360582 10/01/2017 10/01/2018 AGGREGATE $ 5,000,000 DED X I RETENTIONS 0 $ A WORKERS COMPENSATION X PER y STATUTE X ERH AND EMPLOYERS'LIABILITY YIN 0274695 10/01/2017 10/01/2018 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $ FFICER/M EMBER EXCLUDED/andatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 707,Additional Remarks Schedule,may be attached If more space is required) City of Oshkosh,and its officers,council members,agents,employees,and authorized volunteers shall be are listed as additional insured under the General Liability policy as required by written contract,but only in regards to the work performed for the certificate holder by or on behalf of the named insured per blanket form WB1482 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Street Oshkosh,WI 5490 3-1 1 28 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD