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HomeMy WebLinkAboutDR Hansen Plumbing LLC 1-1-18 DRHANSEOPC MMURKEN A COR p DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 11r16r2017 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 Mary Murken,CIC NAME: Murken Insurance LLC PHONE PO Box 3062 (A/c,No,Ext):(920)651-1500 (A/C,No):(866)218-6850 Oshkosh,WI 54903-3062 E-MAILDREss:mmurken@murkeninsurance.com INSURER(S)AFFORDING COVERAGE NAIC• INSURER A:Secure Insurance 22543 INSURED INSURER B: D.R. Hansen Plumbing LLC INSURERC: 55 Knapp Street INSURER D: Oshkosh,WI 54902 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INFO MD IMM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _�_ 1,000,000 CLAIMS-MADE X OCCUR TC3247152 01/01/2017 01/01/2018 DAMAGETORENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ Included GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER EPLI $ 100,000 A AUTOMOBILE LIABILITY COMBINED)SINGLE LIMIT — 1,000,000 X ANY AUTO A3247153 01/01/2017 01/01/2018 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILYBODILY INJURY(Per accident) $ X AUTOS ONLY X AUTOS ONLY (Per PROPERTY A I X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESSLIAB CLAIMS-MADE CU3247155 01/01/2017 01/01/2018 AGGREGATE DED X RETENTION$ 10,000 Aggregate $ 5,000,000 A I WORKERS COMPENSATION X PER H AND EMPLOYERS'LIABILITY STATUTE ER WC3262007 01/01/2017 01/01/2018 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE YNN N/A E.L.EACH ACCIDENT_ _ $ OFFICER/MEMBEER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE,$ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re:Street/Sidewalk Obstruction/Excavation Work in Right-of-Way City of Oshkosh,and its officers,council members,agents,employees,and authorized volunteers are named as additional insureds under general liability form#ILE1037(11/05)and under automobile form#CAE0131 (8/15). 30-day notice of cancellation built into policy language with 10-day notice for nonpayment. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Ave Oshkosh,WI 54901 AUTHORIZED REPRESENTATIVE -11c , ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD