Loading...
HomeMy WebLinkAboutGM Bauman Concrete & Masonry 10-3-18 ACC)R CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) O 4/30/2018 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 NAME: Doreen Janssen Ansay&Associates, LLC. FV PHONE — FAX 4351 W College Ave LAIC,No.Ext►:920-560-7000 (A/C,No):920-560-7079 IL Suite 310 ADDRESS: doreen.janssen©ansay.com Appleton WI 54914 INSURER(S)AFFORDING COVERAGE NAIC• INSURER A:ACUITY,A Mutual Insurance Company 14184 INSURED GMBAUMA-01 INSURER B: GM Bauman Concrete&Masonry LLC &Masonry LLC INSURER C: • N3502 12 Corners Road INSURERD: Appleton WI 54913 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 1381338845 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 SUER POLICY EFF POLICY EXP UMITS LTR INSR WVD POLICY NUMBER IMM/DDIYYYY) (MM/DD/YYYYI A GENERAL LIABILITY Z81916 10/3/2017 10/3/2018 EACH OCCURRENCE $1,000,000 XDAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $250,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE S 2,000,000 GEM_AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 POLICY n iPpa- n LOC $ A AUTOMOBILE LIABILITY Z81916 10/32017 10/3/2018 COMBINED SINGLE LIMIT (Ea accident) $1,000.000 ANY AUTO BODILY INJURY(Per person) S ALL OWNED X SCHEDULED BODILY INJURY(Per accident) S AUTOS _ AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE _ AUTOS (Per accident) S A X UMBRELLA LIAR X OCCUR Z81916 10/3/2017 10/3/2018 EACH OCCURRENCE S 2,000,000 EXCESS Lab CLAIMS-MADE AGGREGATE S 2,000,000 DED RETENTIONS S A WORKERS COMPENSATION 281916 10/32017 10/3/2018 WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY UMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 100,000 OFFICER.MEMBER EXCLUDED? n N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 100,000 If yes.descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Oshkosh ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Avenue PO Box 1130 AUTHORIZED REPRESENTATIVE Oshkosh WI 54903-1130 4'--tee -17 r92 LAL4) .__,/ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD