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Home My WebLink AboutDan Hansen Masonry 7-6-18 10 DATE(MM/DD/YYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE 10/2312017 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 Cindy Casey NAME: Thiel Insurance Group,LLC PHONE FAX 6AfMat,Eat): (A/C,No): 620 N Richmond Street ADDRESS: cindyc@thielinsurancegroup.com INSURER(S)AFFORDING COVERAGE NAIC Appleton WI 54911 INSURER A: Acuity Heritage Insurance 14184 INSURED INSURER B Dan Hansen Masonry INSURER C: Daniel S Hansen INSURER D: 816 Sheboygan St INSURER E: Menasha WI 54952 INSURERF: COVERAGES CERTIFICATE NUMBER: CL17102300861 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. PIER AUDL5UER POLCYEXF POLICY EXP LTR TYPE OF INSURANCE INSD WVD, POLICY NUMBER {MM/DD/YYYY) (MM/DDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 DAMARE NiED CLAIMS-MADE X OCCUR PREMISEESO(Ea omlrrence) 5 100,000 MED EXP(Any one person) 5 5.000 A Z76796 07/06/2017 07/06/2018 1,000,000 PERSONAL 8 ADV INJURY S GENt AGGREGATE LIMIT APPLIES PER' GENERAL AGGREGATE S 2,000,000 X POLICY PRO 2,000,000 JECT LOG PRODOCTS-COMP/OPAGG S OTHER. S AUTOMOBILE LIABILITY COMBINED SINGLE LiMfT S (Ea accident) ANY AUTO BODILY INJURY(Per person) S - OWNED SCHEDULED BODILY INJURY(Per accident) S _ AUTOS ONLY AUTOS HIRED HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accdent) UMBRELLA LAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE 5 DED RETENTION S $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I N ,STATUTE SR ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If mon space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Kuettner Financeial Services LLC ACCORDANCE WITH THE POLICY PROVISIONS. 600 S Main Street,Suite 105 AUTHORIZED REPRESENTATIVE Oshkosh WI 54902ere ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD