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HomeMy WebLinkAboutHoltger Bros Inc 7-1-18 ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/2017 Y) ACOKO O6/27 DDIc' 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 ,d,I this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). c PRODUCER CONTACT L NAME: Aon Risk Services Central, Inc. Green Bay WI Office (NCNo.Ext): (920) 437-7123 (NC.No.): (920) 431-6345 v 111 N. Washington Street, suite 300 E-MAIL o P. 0. BOX 23004 ADDRESS: _ Green Bay WI 54305-3004 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Travelers Property Cas CO of America 25674 HOltoer Bros.. Inc. INSURERB: The Travelers Indemnity Co. 25658 950 W Main Ave De Pere WI 54115 USA INSURERC: Zurich American Ins Co 16535 INSURERD: The Travelers Indemnity Co of CT 25682 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570067252866 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. Limits shown are as requested INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD NIVD POLICY NUMBER (MMIDDIYYYY IIMMIDD/YYYYI LIMITS C X COMMERCIALGENERALI LABILITY DT-00-33166769-PHx-17 07/01/2017 07/01/2018 EACH OCCURRENCE S1,000,000 OCCUR General Liability DAMAGE TO RENTED AL CLAIMS-MADE I X I $300,D00 PREMISES(Ea occurrence) MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 T GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE S2,000,000 'RI POLICY X JECT LOC PRODUCTS-COMP/OP AGG S2,000,000 r- OTHER. o . r B AUTOMOBILE LIABILITY DT-810-37165484-IND-17 07/01/2017 07/01/2018 COMBINED SINGLE LIMIT $1,000,000 N Automobile (Ea accident) X ANY AUTO BODILY INJURY(Per person) 0 Z OWNED SCHEDULED BODILY INJURY(Per accident) ry AUTOS ONLY AUTOS PROPERTY DAMAGE 0 X HIRED AUTOS x NON-OWNED ONLY _AUTOS ONLY (Per accident) _ w t: A X UMBRELLA LIAR X OCCUR CUP-33193250-17-26 07/01/2017 07/01/2018 EACH OCCURRENCE $10,000,000 U UMBRELLA AGGREGATE S10,000,000 EXCESS LIAR CLAIMS-MADE DED X RETENTION$10,000 D WORKERS COMPENSATIONAND UB-3J17180A-17-26-G 07/01/2017 07/01/2018 X PPER EATUTE ERH EMPLOYERS'LIABILITY YIN workers Compensation ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N 1 A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 I!yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S1,000,000- Ai DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) t ADDITIONAL INSURED ON A PRIMARY & NON-CONTRIBUTORY BASIS ON THE GENERAL LIABILITY CITY OF OSHKOSH,--iIAYD'y-r� gS NCIL �11 MEMBERS, AGENTS, EMPLOYEES AND AUTHORIZED VOLUNTEERS AS THEIR INTEREST MAY APPEAR AS RESPECTS THEIWORK pFi7 ! � CE _ ADDITIONAL INSURED ENDORSEMENT AS REQUIRED BY WRITTEN CONTRACT. ---- gn MAR 0 2 2018 CITE'Ci,LIii'd IIFr10E CERTIFICATE HOLDER CANCELLATION - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE P EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ati- a� CITY OF OSHKOSH AUTHORIZED REPRESENTATIVE i 215 CHURCH AVENUE OSHKOSH WI 54903 USA OW s Medec9ftembed K 4� m ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD