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HomeMy WebLinkAboutGreat Lakes Roofing Corp 05-01-18 Aco® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 1/4.....---- 4/25/2017 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 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 HNI Risk Services of Wisconsin NAME:PHONE PO Box 510187 (NC �lL.Eat): 262-782-3940 I((NC,No): 262-782-4198 ADDRESS: certs(hni.com New Berlin WI 53151 INSURER(S)AFFORDING COVERAGE NAICS INSURER A: The Continental Insurance Co.CNA(A:XV) INSURED Great Lakes Roofing Corp. INSURER e: Transportation Insurance Company CNA(A:XV) INSURER C: Valley Forge Insurance Company CNA(A:XV) INSURER D: Continental Casualty Company CNA(A:XV) _ W194 N11095 Kleinmann Drive INSURER E: Germantown WI 53022-3802 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. ILTRR AUUL TYPE OF INSURANCE INSR SOUK WVD POLICY NUMBER POLICY EFF POLICY EXP (MMlDDlYYYI) (MMIDDlYYYY) LIMITS GENERAL LIABILITY A X COMMERCIAL GENERAL LIABILITY Y Y 2064532858 EACH�OCCURRENCE 1 0 0 0 000 05/01/2017 05/01/2018 PREMISES(Ea rrr,Irrencej $S 100000 CLAIMS-MADE [.X 1 OCCUR MED EXP(Any one person) $ 15 000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 7 POLICY X PE-- 7 LOC $ AUTOMOBILE LIABILITY Y 2064532875 COMBINED SINGLE LIMIT B 05/01/201705/01/2018 Ea accident $ 1 000 000 X ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) NON-OWNED X HIRED AUTOS X AUTOS Per accident $ D X UMBRELLA LIAB X OCCUR 2064532889 05/01/201705/01/2018 EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED T X RETENTIONS 10,000 S WORKERS COMPENSATION WC STATU- OTH- C AND EMPLOYERS'LIABILITY Y/N 264532892 05/01/201705/01/2018 X TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICE/MEMBER EXCLUDED? N NIA 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE: $ 100,000 If yes,describe under nF RCRAPTI/N nF nPFRATIONC hPMw E.L.DISEASE-POLICY LIMIT $500,000 A Inland Marine 2064532858 05/01/201705/01/2018 Leased or Rented $140,000 Physical Damage DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) REcrtvED The certificate holder is included as additional insured on General Liability I 1 as required by written contract or agreement,with respect to work performed by �N� + w �1� 1 the Named Insured. b , CERTIFICATE HOLDER CANCELLATION City of Oshkosh SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn:City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1130 215 Church Avenue AUTHORIZED REPRESENTATIVE Oshkosh WI 54903-1130 --S�y ©1988-2010 ACORD CORPORATION.� All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD