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HomeMy WebLinkAboutDirectional Drilling Services of WI Inc 5-31-18 Aco® CERTIFICATE OF LIABILITY INSURANCE °ATE'MM'°°`Y""' 2/14/2018 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 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: DIN Hauge An say&Associates, LLC. GB PHONE FAX 419 South Washington Street tivc.No.Ext):920 437-0587 (A/c,No):920-437-4179 IL PO Box 22368 ADDRESS: Bri.Hauge@ansay.com Green Bay WI 54305 INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:Sentry Insurance a Mutual Company 24988 INSURED DIREDRI-01 INSURER B: Directional Drilling Services of WI, Inc. 3671 Buyarski Road INSURERC: Green Bay WI 54311 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:645822470 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 I TYPE OF INSURANCE INSR S NYIZ POLICY NUMBER POLICY EFF POLICY EXP UMITS (MMIDDIYYYY) (MMlDD/YYYY) A GENERAL LIABILITY Y A0081104004 5/31/2017 5/312018 EACH OCCURRENCE $1.000,000 X DAMAGE—TO RENTED COMMERCIAL GENERAL LIABILITY PREMISESJEa occurrence) $500,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PE� X LOC - a A AUTOMOBILE LIABILITY A0081104001 5/31/2017 5/31/2018 COMBINED SINGLE LIMIT (Ea acddeM, $1.000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS I AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) S A X UMBRELLA UAB X OCCUR A0081104008 5/31/2017 5/31/2018 EACH OCCURRENCE $10,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $10,000,000 DED X RETENTIONS 0 E A WORKERS COMPENSATION A0081104005 5/31/2017 5/312018 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED, N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF,PERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) City of Oshkosh,and its officers,council members,agents,employees and authorized volunteers are included as additional insured with regards to the above General Liability policy per form CG7021. 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. P.O. Box 1130 Oshkosh WI 54903 AUTHORIZED REPRESENTATiVE USA ©1988-2010 ACORD CORPORATION, All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD