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Dorner Inc 6-1-18
------.-""./ oo DATE(MM/DD/YYYY) A�oKo CERTIFICATE OF LIABILITY INSURANCE 02/06/2018 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 4: certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 5 PRODUCER CONTACT N NAME: L Aon Risk Services Central, Inc. PHONE FAX Green Bay WI offi Ce (NC.No.Eat): (920) 437-7123 (A/C.No.): (9Z0) 431-6345 M 111 N. washington Street, Suite 300 E-MAIL c P. 0. Box 23004 ADDRESS: _ Green Bay WI 54305-3004 USA INSURER(S)AFFORDING COVERAGE NAIL A INSURED INSURER A: BITCO National Insurace company 20109 Dorner, Inc INSURERB: Travelers Property Cas Co of America 25674 E506 Luxemburg Road P. O. BOX 129 INSURER C: Luxemburg WI 54217 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570070155598 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. Limits shown are as requested INSR ADDL SUBIT POLICY EFF POLICY EXP I.TR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDnnvvvvvv)� MMIDOIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLP 3 653 300 06/01/2017 06/01/2018 EACH OCCURRENCE S1,000,000 CLAIMS-MADE I (OCCUR GENERAL LIABILITY DAMAGE TO RENTED S300,000 PREMISES(Ea occurrence) X XCU MED EXP(Any one person) S10,066 X contractual Liab PERSONAL 8 ADV INJURY $1,000,000 rn GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE S2,000,000 ^_ POLICY I IPE� n LOC PRODUCTS-COMP/OPAGG S2,000,000 n 0 OTHER o r A AUTOMOBILE LIABILITY .CAP 3 654 302 06/01/2017 06/01/2018 COMBINED SINGLE LIMIT S1,000,000 AUTO (Ea accident) .• X ANY AUTO BODILY INJURY(Per person) 0 Z OWNED SCHEDULED BODILY INJURY(Per accident) N AUTOS ONLY AUTOS PROPERTY DAMAGE t6 X HIRED AUTOS x NON-OWNED V (Per accident) ONLY AUTOS ONLY '� _ a1 B X UMBRELLALIAB IX OCCUR ZUP-15N94504-17-NF 06/01/2017 06/01/2018 EACH OCCURRENCE 58,000,000 0 UMBRELLA AGGREGATE S8,000,000 EXCESS LIAR CLAIMS-MADE DED 'RETENTION A WORKERS COMPENSATION AND WC 3 654 301 06/01/2017 06/01/2018 X PER OTH- EMPLOYERS'LIABILITY YIN WORKERS COMPENSATION STATUTE ER ANY PROPRIETOR I PARTNER r EXECUTIVE I E.L.EACH ACCIDENT S500,000 OFFICER/MEMBER EXCLUDED' I N N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S500,000 If yes,descnbe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000- MI DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101,Additional Remarks Schedule,may be attached if mom space is required) RE: ANNUAL EXCAVATION/WORK IN RIGHT-OF-WAY BOND. ADDITIONAL INSURED ON THE GENERAL LIABILITY CITY OF OSHKOSH, ITS EMPLOYEES AND y OFFICERS AS RESPECTS TO THE WORK BEING DONE PER BLANKET ADDITIONAL INSURED ENDORSEMENT, AS REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF OSHKOSH AUTHORIZED REPRESENTATIVE 215 CHURCH AVENUE El PO BOX 1130 OSHKOSH WI 54903 USA 8 `�J �y�� O ' W f J {, IIII ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD