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HomeMy WebLinkAboutEGI Mechanical 7-1-18 DATE(MM/DD/YYYY) Ac o® CERTIFICATE OF LIABILITY INSURANCE 6/5/2017 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). CONT PRODUCER NAMEACT Jodi Tousey Ansay&Associates, LLC. GB PHONE 800-236-8652 FAX 920-437-4179 419 South Washington Street (A/CAL Est: WC.Not: E-MPO Box 22368 ADDRESS:Jodi.Tousey@ansay.com Green Bay WI 54305 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Secura Insurance A Mutual Company 22543 INSURED EGIMECH-01 INSURER B: EGI Mechanical Inc INSURERC: Joe Pues PO Box 65 INSURER D: Seymour WI 54165 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 842859136 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CP3240089 7/1/2017 7/1/2018 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 PRO- POLICY X JECT X LOC PRODUCTS-COMP/OPAGG $3,000,000 OTHER $ A AUTOMOBILE LIABILITY A3240090 7/1/2017 7/1/2018 (Ea accident) $1,000,000SINGLE LIMIT $1 000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OS/NED SCHEDULED BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) A X UMBRELLA LIAB X OCCUR CU3240092 7/1/2017 7/1/2018 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$10,000 $ A WORKERS COMPENSATION WC3240091 7/1/2017 7/1/2018 XPEROOTH STATUTE AND EMPLOYERS'LIABILITY Y!N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED'? N NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Hired/Rented Equipment CP3240089 7/1/2017 7/1/2018 Limit 225,000 Deductible 500 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) RECEIVED VED JUN 0 8 2017 CITY CLERK'S OFFICE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1130 Oshkosh WI 549031130 USA AUTHOOORRIRIIIZZEDREPRESENTATIVE /04.-/ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD