Loading...
HomeMy WebLinkAboutD&J Quality Construction LLC 12-1-18 �"1 D&J0000001 CLUESCHEN '4C'ORD a CERTIFICATE OF LIABILITY INSURANCE DATE(MMLDDrrYYY) `------- 04/02/2018 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). 1 PRODUCER ACT The Diedrich Agency PHONE 222 Blackburnt Miss: (NC,No,EA):(920)748-2811 (Fac,No):(920)748-5044 Ripon,WI 54971 iss: INSURERS)AFFORDING COVERAGE NAIC 0 INSURERA:ACUity 14184 — INSURED INSURER B: D&J Quality Construction LLC INSURER C: 1840 Evan St INSURERD: Oshkosh,WI 54901 f 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD. 4MM/OD/YYYYI IMMIDD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR Z34229 12/01/2017 12/01/2018 DAMAGETORENTED 100,000 X PREMISES(Ea ocaxrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X 5311a X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE UABILITY COMBINED SINGLE LIMIT 1,000,000 _LEa accident $ X ANY AUTO )( Z34229 12/01/2017 12/01/2018 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSRE� ONLY AUTOS BODILY BODILY INJURY(Per accident) $ X , AUTOS ONLY X AUTOS ONLY 1ParPROPERTYaccident) $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1'000,000 EXCESS LIAB CLAIMS-MADE Z34229 12/01/2017 12/01/2018 AGGREGATE s 1,000,000 DED RETENTIONS $ A WORKERS COMPENSATION X PER RTUTE 0T H- AND EMPLOYERS'LIABILITY Z34229 12/01/2017 12/01/2018 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ER YNN N/A E.L.EACH ACCIDENT $ ;rl atl En BgEE 1 EXCLUDED? i NH E.L.DISEASE-EA EMPLOYEES 100,000 If es,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) . Additional Insureds on all liability policies for liabilitly arising out of project work include j—Ric Ric jL+* ,,. City of Oshkosh,and its officers,council members,agents,employees and authorized volunteers and include Products-C.mp eted p tl ns fa)min t um of 2 years with a 30 day notice of cancellation mAypd2818 a CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Oshkosh,Attn:CityClerk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Avenue PO Box 1130 Oshkosh,WI 54903 AUTHORIZED REPRESENTATIVE � _,coe.,,ice / ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD