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HomeMy WebLinkAboutC.D. Smith Construction 10-1-18 ACC)R0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1.----- 9/25/2017 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 CONTACT NAME: Renee Senso Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX FAX 920-734-3637 101 Camelot Drive, Suite 2C (A/C No,FM. (A/C.No): Fond du Lac WI 54935 E-MAIL renee_senso a ADDRESS: jgcom INSURER(S)AFFORDING COVERAGE NAIC a _ INSURERA:The Travelers Indemnity Company of CT 25682 INSURED INSURER B:Great American Insurance Company 16691 C.D. Smith Construction, Inc. INSURERC: PO Box 1006 Fond du Lac, WI 54936-1006 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1896780799 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 SUER POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER IMM/DD/YYYY) (MM/DD/YYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY Y CO-4H840632 10/1/2017 10/1/2018 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $300,000 MED EXP(Any one person) $10,000 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY X JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER. $ A AUTOMOBILE LIABILITY Y 810-4H840632 10/1/2017 10/1/2018 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY ^ AUTOS ONLY (Per accident) $ B X UMBRELLA LIAB X OCCUR Y TUU019530907 10/1/2017 10/1/2018 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$10,000 $ A WORKERS COMPENSATION UB-4H928501 10/1/2017 10/1/2018 PER OTH- AND EMPLOYERS'LIABILITY Y/N X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 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 volunteers are additional insureds on the general liability, auto liability and umbrella liability policies on a primary and on-contributory basis for both ongoing and completed operations. Policies include a 30 day notice of cancellation to the . of er. Project:Annual Sidewalk Layers License 1`/V, JO 02 2018 CERTIFICATE HOLDER --- --Fv>1Ci CANCELLATION an' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 Church Ave ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1130 Oshkosh WI 54903-1130 AUTHORIZED __RREPRESENT 9TIIVE ,! L.r 51 r}7a p( U�+r( �Gt h� { I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD