HomeMy WebLinkAboutGriese Construction of the Fox Valley 5-11-18 ACQ® DATE(MMIDD/YYYY)
C CERTIFICATE OF LIABILITY INSURANCE 03/31/2017
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 JOLENE SZUCS
NAME:
PHONE 920-924-3995 FAz 920-921-5834
LAIC.No.Exy: (MC.No):
JOLENE SZUCS ADDRESS: )SZUCSI'C�rUrallnS.00m
101 WISCONSIN AMERICAN DRIVE SUITE 300 INSURERS)AFFORDING COVERAGE NAICS
FOND DU LAC WI 54937 INSURERA: RURAL MUTUAL INSURANCE COMPANY 15091
INSURED INSURER B
INSURER C:
GRIESE CONSTRUCTION OF THE FOX VALLEY INSURERD:
6061 STATE ROAD 91 INSURER E:
OSHKOSH WI 54904 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.
LTR TYPE OF INSURANCE Sj vi POLICY NUMBER (IMP POLICY
YYY) (IMt)DWYYYY) LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAGE TO RENTED
CLAIMS-MADE X OCCUR PRISES SES(Ea occurrence) $ 100.000
X BUSINESSOWNERS MED EXP(My one person) $ 5,000
A BOPG122698 05/11/2017 05/11/2018 PERSONAL ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $ 2,000,000
-CO
POLICY JEC LOCPRODUCTSMP/OP AGG $ 2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
(Ea accident)
ANY AUTO BODILY INJURY(Per person) S
A OWNED X SCHEDULED BAPG122710 05/11/2017 05/11/2018 BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
$
UMBRELLA'JAB OCCUR EACH OCCURRENCE S
EXCESS!JAB CLAIMS-MADE AGGREGATE S
DED RETENTIONS $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY STATUTE ER
Y N
ANYPROPRIETOR/PARTNER/EXECUTIVE / N/A WRKG122712 05/11/2017 05/11/2018 E.L.EACH ACCIDENT $ 100,000
A OFFICER/MEMBEREXCLUDED? N
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000
If yes.describe under 000
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 required)
CITY OF OSHKOSH,AND ITS OFFICERS,COUNCIL MEMBERS,AGENTS,EMPLOYEES,AND AUTHORIZED VOLUNTEERS ARE INCLUDED AS
ADDITIONAL INSURED ON THE PRIMARY&NON-CONTRIBUTORY BASIS FOR GENERAL LIABILITY,AUTO&UMBRELLA WITH REGARDS TO WORK
PREFORMED BY THE NAMED INSURED.ALL INSURANCE POLICIES SHALL NOT BE CANCELLED OR RESTRICTIVE MODIFICATIONS ADDED
WITHOUT THIRTY(30)DAYS PRIOR WRITTEN NOJ TI E-IO OSHKOSH CITY CLERK.
( RE.
�pR 01 2017
CERTIFICATE HOLDER ._---.'CANCELLATION
Ut
CATS L_t d, 'S
lJ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
PROFESSIONAL PROPERTY MANAGEMENT GROUP LLC
AUTHORIZED REPR E ATIVE
973 FEATHERSTONE RD SUITE 300
ROCKFORD IL 61107
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