The URL can be used to link to this page

Home My WebLink AboutFred Litjens 6-20-18 /....N LITJCON-01 PKRUEGER ACC)RO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �/ 08/03/2017 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: Ansay 8 Associates,LLC. FV PHONE FAx 920 560-7078 4351 W College Ave (A/c,No,Est):(920)560-7000 (A/C,No):( ) Suite 310 j.iflfol@ansay.com Appleton,WI 54914 INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Society Insurance A Mutual Insurance Company 15261 INSURED INSURER B: Fred Litjens INSURER C 3327 Nelson Road INSURER D: Appleton,WI 54914 - 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 ADOL SUER POLICY NUMBER IY POLICY EFF POLICY EXP LIMITS LTR INSD WVD Mt INM/DD/YYYY1 A X COMMERCIAL GENERAL UABIUTY I EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR BP17018390 06/20/2017 06/20/2018 DAMAGE TO RENTED I S(Ea2nQrice) $ MED EXP(My one person) $ _ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PET LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT i (Ea accident) _ I$ ANY AUTO BODILY INJURY(Per person) I $ OWNED SCHEDULED AUTOS�� ONLY AUTOSyWyryry _BODILYR INJUOPEIRTY RY(Per exident)1$ AUTOS ONLY AUUTOS ONLY P(Per accdentOAMAGE $ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE _, ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED/ N I A (Mandatory in NH) E L.DISEASE-EA EMPLOYEE $ If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is requiredJ�i�J.Li � AUG042017 1 cricIE LCE ITYCLERKSO CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CityACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1130 Oshkosh,WI 54 90 3-1 1 3 0 AUTHORIZED REPRESENTATIVE CZ0.Nv` ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD