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HomeMy WebLinkAboutFireline Sprinkler Corp 7-7-18 DATE(MM/DDNYYY) A C� CERTIFICATE OF LIABILITY INSURANCE 7/15/2017 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 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: M3 Insurance Solutions, Inc. PHONE FAX 3406 Oakwood Hills Parkway, Suite 400 (A/C,No,Est):715-830-1840 (Aic,Net: 715 830 0159 Eau Claire WI 54701 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC Ik INSURER A:Travelers Property&Casualty 25674 INSURED INSURER B The Travelers Indemnity Co. 36137 Fireline Sprinkler Corp. INSURER D:UNDERWRITERS AT 15792 5036 Clairemont Drive INSURER D:UNDERWRITERS AT LLOYDS 32727 Appleton WI 54913 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 998340480 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 SUER POUCY EFF POUCY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY DT-CO-7J118738-PHX-17 7/7/2017 7/7/2018 EACH OCCURRENCE $1,000,000 DAMAGE TO CLAIMS-MADE X OCCUR PREMISES(EaENTED occurrence) $300,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X Ter- LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER $ A AUTOMOBILE LIABILITY DT-810-7J118702-TCT-17 7/7/2017 7/7/2018 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY (Per accident) A X UMBRELLA LIAB X OCCUR CUP-7J120193-17-26 7/7/2017 7/7/2018 EACH OCCURRENCE $10,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE $10,000,000 _ DED X I RETENTION$10,000 $ A WORKERS COMPENSATION UB-7J116548-17-26-V 7/7/2017 7/7/2018 X PER ERH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E L DISEASE-EA EMPLOYEE $1,000,000 If yes describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT i $1,000,000 BLeased/Rented Equipment 2H593616 7/7/2017 7/7/2018 Limit Per Item 250,000 D Professional 16LFSPLD067 7/7/2017 7/7/2018 Occur/Aggregate 2,000,000 Pollution PGIARK0462103 7/7/2017 7/7/2018 Occur/Aggregate 2.000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CITY OF OSHKOSH, ITS OFFICERS, COUNCIL MEMBERS, AGENTS, EMPLOYEES, AND AUTHORIZED VOLUNTEERS-SHALL NAMED ADDITIONAL INSUREDS WITH REGARD TO GENERAL LIABILITY ATIMA RE En12_ _ JUL 2 4 2017 CITY CLERICS I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF OSHKOSH CITY CLERK THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 CHURCH AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. OSHKOSH WI 54903 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD