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HomeMy WebLinkAboutHickey Roofing Inc 4-23-18 HICKE-2 OP ID: RG ACORD DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/31/2017 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 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: Brian McGlone McClone-Oshkosh PHONE 920-233-4000 FAX 505 North Westfield Street lac.No,Eat): (ac,No): 920-233-2728 Oshkosh,WI 54902-4105 ADDRESS:MA brian.mcclone@mcclone.com Brian McGlone INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:SECURA Insurance 22543 INSURED Hickey Roofing, Inc. INSURER B:Middlesex Insurance Co 23434 Mr. William Hickey 1427 Broad Street INSURER C Oshkosh,WI 54901 INSURER D: INSURER E: 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. INSR TYPE OF INSURANCE AWL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X CP3235984 04/23/2017 04/23/2018 MG TSOR EoNccTuErDrence) $ 100,000 MED EXP(Any one person) $ 5,000 X Agg Per Project PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY L X PRO- POLICY LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) r A X ANY AUTO A3235985 04/23/2017 04/23/2018 BODILY INJURY(Per person) $ ALL OWNED ' SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION x PER OTH- AND EMPLOYERS'LIABILITY _ STATUTE ER Y/N B ANY PROPRIETOR/PARTNER/EXECUTIVE 89-27845-02 00 131 04/23/2017 04/23/2018 E L.EACH ACCIDENT $ _ 100,000 OFFICER/MEMBER EXCLUDED/ N/A (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ 100,000 Eyes,describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ 500,000 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 Additional Insured with respects to General Liability Coverage per form ILE 1037 11/05. A 30 Day Notice of Cancellation applies in favor of the City of Oshkosh. CERTIFICATE HOLDER CANCELLATION OSHKOSI 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 215 CHURCH AVENUE P.O. BOX 1130 AUTHORIZED REPRESENTATIVE P.O. BO SH,WI 54902-1130 Brian McClon ave._ OSHKO ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD