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HomeMy WebLinkAboutCarl Bowers & Sons 4-1-18 ACC DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1/23/2018 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 CONTACT Spectrum Insurance Group GB PHONE Mary McLennan FAX 303 Packerland Dr., Ste C IA/C.No.Extl: 920-884-2850 (A/C,No):920-884-2851_ Green Bay WI 54307 ADDRESS: Mary.McLennan@spectruminsgroup.com INSURER(S)AFFORDING COVERAGE NAIC I INSURER A:West Bend Mutual 15350 INSURED CARLB-2 INSURER B: Carl Bowers&Sons Construction Co., Inc. INSURER C: N 1844 Maloney Rd INSURERD: Kaukauna WI 54130 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1180941927 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 ADDL SUBRI POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD I POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) UMITS A X COMMERCIAL GENERAL LIABILITY Y 184463303 4/1/2017 4/1/2018 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $200,000 MED EXP(Any one person) $10,000 PERSONAL S ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2.000,000 POLICY X PE 4 X LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY 1844633 03 4/1/2017 4/1/2018 COMBINED SINGLE LIMIT S (Ea accident) 1 000.000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY (Per accident) A X UMBRELLA LIAB X OCCUR 1844633 03 4/1/2017 4/1/2018 EACH OCCURRENCE $5.000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION S S A WORKERS COMPENSATION 184463303 4/1/2017 4/1/2018 X STATUTE EORH AND EMPLOYERS'LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $500.000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 A Leased Equipment 1844633 03 4/1/2017 4/12018 Leased Equipment 350,000 I Installation Floater Installation Job Site 100,000 Deductible 1,000 DESCRIPTION OF OPERATIONS I 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 volunteers are listed as addditional insured regarding General Liability as required by written contract. _RECE,IVED CERTIFICATE HOLDER JAN 24 2018 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY CLERK'S OFFICE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Oshkosh ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Ave PO Box 1130 AUTHORIZED REPRESENTATIVE Oshkosh WI 54903 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD