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HomeMy WebLinkAboutCondon Oil Company 7-1-18 t Sandra R Mohan.CIC.PWCAM FaxID Johnson Insurance Date 6/92017 12 53 01 PM Paae:2 of 2 CONDOIL-01 SMOHAN ` R/Jr DATE(MM/DDrYYYY) 6(MM/DI CERTIFICATE OF LIABILITY INSURANCE 7 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 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 Sandra R. Mohan, CIC� PWCAM NAME: Johnson Insurance Northeast PHONE 920 445-7451 FAX 877 254-8586 318 South Washington Street (NC,No,Eat):( lac,No): Green Bay,WI 54301 a DAREss:smohan@johnsonins.com INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:Argent INSURED INSURER B Condon Oil Company Inc INSURER C 126 East Jackson P.O.Box 184 INSURER D: Ripon,WI 54971 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. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POUCY EXP LIMITS LTRINSD WVD POLICY NUMBER (MMIDDIYYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 DAMAGE TO RENTED CLAIMS-MADE j OCCUR PREMISES(Ea occurrence) S MED EXP Any one person) $ PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY PET LOC PRODUCTS-COMP/OP AGG S OTHER: $ AUTOMOBILE LIABILITY • COMBINED SINGLE LIMIT $ (Ea accident) • ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED I PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS 1 (Per accident) I $ UMBRELLA UAB OCCUR EACH OCCURRENCE - - I EXCESS LIAB CLAIMS-MADE i AGGREGATE S DED RETENTION$ WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE OTH- ER A ANY PROPRIETOR/PARTNER/EXECUTIVE V/N A023729 07/01/2017 07/01/2018 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? Nj N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) RECEIVED_ Re:Monitoring System for Pollution Tracking JUN132017 CITY CLERICS®SCE 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. PO Box 1130 Oshkosh,WI 54901 AUTHORIZED REPRESENTATIVE I I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD