Loading...
HomeMy WebLinkAboutElexco Inc 7-1-18 9-2017 11:57 AM 1 Fax Certificate of Insurance 1 �o CERTIFICATE OF LIABILITY INSURANCE DATE(MMDD/YYYY) `,� 6/29/2017 HIS 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 NAME: Cottingham& Butler PHONE 563-587 5000 FAx 563-583-7339 E-MAILolin GreenQFxu IA/C.Nol: E-MA 800 Main St. ADDRESS' Dubuque IA 52001 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Continental Western Insurance Company 10804 INSURED ELEXC-1 INSURER B: ELEXCO INC. INSURER C: 423 E BRONSON ROAD SEYMOUR WI 54165 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 553550720 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 ADM SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD W VD POLICY NUMBER (MMIDDIYYYY) (MMlDDIYYYY) A X COMMERCIAL GENERAL LIABILITY CA 3171370 7/1/2017 7/1/201B EACH OCCURRENCE _$1000,000 CLAMS-MADE X OCCUR PREMISES(Ea occurrence) S 300;D00 MED EXP(Any one person) $10,000 PERSONAL 8 ADV INJURY $1 000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE _$2 000,000 X POLICY X PE X LOC PRODUCTS-COMPADP AGG $2 000:000 OTHER' $ A AUTOMOBILE LIABILITY CPA 3171370 7/1/2017 7/1/2018 t-UMBINEU SINULL LIMI I $ (Ea accident) 1 000.000 X ANY AUTO BODILY INJURY(Per person) $ OWNEDONLY SCHEDULED BODILY INJURY(Per accident) $ AUTOSHIRED NON-OWNED PROPLKIY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) A X UMBRELLA LAB X OCCUR CPA 3171370 7/1/2017 7/1/2018 EACH OCCURRENCE $5 000:000 EXCESSLIAB CLAIMS-MADE AGGREGATE $5000.000 DED RETENTION$ $ A WORKERS COMPENSATION WCA 3171371 7/1/2017 7/1/2018 PER OTH• AND EMPLOYERS'LIABILITY YIN X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $1 000:000 OFFICER/MEMBER EXCLUDED? ri (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S1 000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE POLICY LIMIT $1.000;000 l DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) The City of Oshkosh, its Officers, Council Members,Agents, Employees and Authorized Volunteers are addijal ^^"•^�+ ^^����e t3eFs' liability policy subject to all terms and conditions of the policy forms. RECEIVE_ JUN 3 0 2017 CITY CLERICS OFFICE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 Church Street ACCORDANCE WITH THE POLICY PROVISIONS. Oshkosh WI 54903 AUTHORIZED REPRESENTATIVE ! ,0-4:1 .g/tte,"" ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD