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HomeMy WebLinkAboutGene Frederickson Trucking 10-1-18 � ® DATE(MM/DDNYYY) A CO CERTIFICATE OF LIABILITY INSURANCE 12/19/2017 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 Spectrum Insurance Group GB PHONE Mary McLennan FAX 303 Packerland Dr., Ste C (A/C,No):920-884-2851 tar,Ext): 920-884-2850 Green Bay WI 54307 ADDRESS: Mary.McLennan@spectruminsgroup.com INSURER(S)AFFORDING COVERAGE NAIC H INSURER A:Sentry Insurance - INSURED GENEF-1 GENE FREDERICKSON TRUCKING INC INSURER B: GF INC OF WI, DMS LTD, COBBLE INSURER C: 4450 FIELDCREST DR INSURERD: KAUKAUNA WI 54 1 30-45 39 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:423891061 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 LIMITS LTR INSD WVD POLICY NUMBER IMM/DDNYYYI IMM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y A0040209004 10/1/2017 10/12018 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $500,000 MED EXP(Any one person) $10,000 PERSONAL 8 ADV INJURY $1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY X J JECOT- X LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER $ A AUTOMOBILE LIABILITY A0040209001 10/1/2017 10/1/2018 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 $ AUTOS ONLY AUTOS ONLY (Per accident) A X UMBRELLA LIAB X OCCUR A0040209006 10/1/2017 10/12018 EACH OCCURRENCE $5,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000 DED I X RETENTION$10 000 $ A WORKERS COMPENSATION A0040209005 10/1/2017 10/1/2018 X STATUTE EORH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE Y N 1A E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 A Contractors Equipment A0040209003 10/12017 10/1/2018 Hired or Leased $700,000 Contractors Pollution Deductible 1,000 w/$5.000 deductible Contractors Pollution $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Gene Frederickson is excluded for Workers'Compensation coverage City of Oshkosh,and it officers,council memberd,agents,employees and authorized volunteers are included as additional Insured for general liability CERTIFICATE HOLDER CANCELLATION 30 Days SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Oshkosh PO Box 1130 AUTHORIZED REPRESENTATIVE Oshkosh WI54903 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD