Loading...
HomeMy WebLinkAboutConcrete Cutters 7-14-18I AC o® CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DD YYYY) `---- 03/02/2018 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 NAME: Scott Van D_rn Hoven ONE Van Dyn Hoven Insurance (NCC,N_E,e)_ (920)788-3530 Atc,NO):(920)788-5948 534 Pine Street ADDRESS: scott@vdhinsurance.com Little Chute,WI 54140 INSURER(S)AFFORDING COVERAGE NAIC 0 _ INSURERA: Wilson Mutual INSURED INSURER B: Concrete Cutters Inc. INSURER C: P O Box 75 INSURER D: Kaukauna,WI 54130 INSURERE: INSURER F: . COVERAGES CERTII,LATE NUMBER: 00000000-1217271 REVISION NUMBER: 250 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 EFF POLICY EXP(MVO LTR, INSD VD, POLICY NUMBER IMM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y 3201677580 07/14/2017 07/14/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) S 100,000 MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER' GENERAL AGGREGATE S 2,000,000 POLICY I X I jE 6 I I LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY 3201677580 07/14/2017 07/14/2018 COMBINED SINGLE LIMIT(Ea accident) $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED _,AUTOS ONLY X AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) __ -_ $ A X UMBRELLA LIAB OCCUR 3201677580 07/14/2017 07/14/2018 EACH OCCURRENCE $ 6,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE S 6,000,000 DED RETENTION$ S A WORKERS COMPENSATION 3201677580 07/14/2017 07/14/2018 PER STATUTE OTH- ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT S 500,000 OFFICER/MEMBER EXCLUDED' 1-7NIA (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 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) _` T�r,r•D Additional Insured:City of Oshkosh,and its officers,council members,agents,employees,and authorized volunteers • I MAR 0 7 201a CITY CLERIC'S OFFICE • 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. 215 Church St Oshkosh,WI 54903 AUTHOR IZE EDD REPRESENTATIVE „(Iiiti7 Q. (SPV) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by SPV on March 02,2018 at 02:05PM