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HomeMy WebLinkAboutC.R. Meyer & Sons Company 6-1-18 A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 5/31/2017 I 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 NAME: M3 Insurance Solutions, Inc. PHONE FAX 3406 Oakwood Hills Parkway, Suite 400 (A/C,No,Ext):715-830-1840 (A/C,No):715-830-0159 Eau Claire WI 54701 ADDRESS: -ackie.plaszcz@m3ins.COm PRODUCER CUSTOMER ID#:MEYEC-2 INSURER(S)AFFORDING COVERAGE NAIC N INSURED INSURER A:The Travelers Indemnity Co. 36137 C.R. Meyer & Sons Company INsuRERe:Westchester Fire Insurance Co. 895 West 20th Avenue PO Box 2157 INSURER c:Arch Specialty Insurance Co. Oshkosh WI 54903-2157 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:487075968 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 ADDLTYPE OF INSURANCE INSR WVDSUER POLICY NUMBER IMPM/DD/YLICY YYYI (MM/DF D/YYYY) LIMITS Y EXP LTR INSR WVD A GENERAL LIABILITY 5185N287 6/1/2017 6/1/2018 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $300,000 CLAIMS-MADE I X I OCCUR MED EXP(Any one person) $10,000 PERSONAL i.ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 7 POLICY X JECT PRO- LOC $ A AUTOMOBILE LIABILITY 9497L547 6/1/2017 6/1/2018 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS $ $ A X UMBRELLA LIAB X OCCUR 9497L559 6/1/2017 6/1/2018 EACH OCCURRENCE $25,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $25,000,000 DEDUCTIBLE $ X RETENTION $10,000 _ _ $ A WORKERS COMPENSATION VTRJUBS138N667 - WI 6/1/2017 6/1/2018 X WC STATU- G'TH- A ANDEMPLOYERS'LIABILITY Y/N VTC2EUB5962N80-6-17- AOS 6/1/2017 6/1/2018 TORY LIMITS 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 A Rented Equipment QT6609509L759-TIA-17 6/1/2017 6/1/2018 Per Item 1,000,000 B Pollution Liability G28155505001 8/25/2016 8/25/2018 Occur\Aggregate 2,000,000 C Professional Liability CPPOOSS311-04 6/1/2017 6/1/2018 Occur\Aggregate 5MM\10MM DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE: working in the right of way City of Oshkosh and its officers, counsil members, agents, employees and authorized volunteers are additional insureds with regard to General Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED City of Oshkosh IN ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Avenue PO Box 1130 Oshkosh WI 54903 AUTHORIZED REPRESENTATIVE I I ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD