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HomeMy WebLinkAboutGabe's Construction Company Inc 7-1-18 ACCPREP CERTIFICATE OF LIABILITY INSURANCE 6A23/2017rr) 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). PRODUCER CONTACT Christine Miramontes NAME: R&R Insurance Services Inc AAICONN E:n: (262)574-7000 FAX A/c.Nol: (262)574-7080 1581 E Racine Avenue E-MAIL ADDRESS:debbie.madsen@rrins.com PO Box 1610 INSURER(S)AFFORDING COVERAGE NAIC# Waukesha WI 53186 INSURER A:Zurich-American Ins Group 16535 INSURED INSURER a:Continental Casualty 20443 Gabe's Construction Company Inc INsuRERcAmerican Guarantee & Liability 26247 4804 N 40th St INSURERD: PO Box 385 INSURER E: Sheboygan WI 53 082-03 85 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1762375304 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 SUBR POLICY EFF POLICY EXP UNITSLTR INSR WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 300,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ A CLAIMS-MADE X OCCUR GLO 5542714-05 7/1/2017 7/1/2018 MEDEXP(Anyoneperson) $ 10,000 X $5,000 PD Deductible PERSONAL&ADV INJURY $ 1,000,000 X Blkt AI w/PNC & WOS #U-GL-1175-F-CW (AI/PNC) GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: #II-GL-925-B (WOS) PRODUCTS-COMP/OP AGG $ 2,000,000 7 POLICY X PROT LOC $ EG AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO BAP 5542712-OS BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED 7/1/2017 7/1/2018 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED #CAA 20 48 10 13 (AI/PNC) PROPERTY DAMAGE $ AUTOS (Per accident) X Blanket WOS X Blanket Al/PNC #CA 04 44 10 13 (NOS) $ C X UMBRELLALIAB fX OCCUR A,OC 03 83 915-00-Lead $10M 7/1/2017 7/1/2018 EACH OCCURRENCE $ 20,000,000 B X EXCESSLIAB CLAIMS-MADE 5094893207-Excess $10M AGGREGATE $ 20,000,000 DED X RETENTION$ 10,000 #U-UMB-103-C CW 7/1/2017 7/1/2018 $ C WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY OMITS ER ANYICE OPRIETOOR PARTNE DEEXCLUDp ECUTIVE N N!A E.L.EACH ACCIDENT $ 1,000,000 O(Mandatory In NH) WC 5542715-05 7/1/2017 7/1/2018 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 Installation Floater CPP 5542721-05 7/1/2017 7/1/2018 Job Site 1,000,000 Leased/Rented Equipment CPP 5542721-05 7/1/2017 7/1/2018 Per Item 500,000 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) City of Oshkosh and its officers, council members, agents, employees and authorized volunteers are Additional Insured for General Liability (includes ongoing & completed operations) and Auto Liability (per forms above) on a primary and non-contributory basis as required by contract. 30-Day Notice of Cancellation applies in favor of the certificate holder; except for non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Oshkosh Q 2 �� THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN S ACCORDANCE WITH THE POLICY PROVISIONS. Department of Public Wo k vicE - & City Clerks Office C1,�YJA�CL,t,i.C.P.- � AUTHORIZED REPRESENTATIVE 215 Church Avenue PO Box 1130 -- -f, Oshkosh, WI 54903-1130 Thomas Scheider/DM586 ---_ --_--= � ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSU7S r7mnnsi m Thera Aropn namo anr4 Innn am ronictornrl markc of Arnim