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HomeMy WebLinkAboutJF Ahern Co 11-1-17 DATE(MM/DD/YYYY) ...1 Ro CERTIFICATE OF LIABILITY INSURANCE 07/20/2017 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 ,=°-1 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 5 0 CONTACT PRODUCER NAME: 1 Aon Risk Services Central, Inc. -- - Green Bay WI office (A/CNNo.Eel): (920) 437-7123 FAX No.): (920) 431-6345 m 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: Zurich American Ins CO 16535 I. F. Ahern CO. INSURER B: Starr Indemnity & Liability Company 38318 855 Morris Street - Fond du Lac WI 54935-5611 USA INSURERC: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570067611468 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MMIDD (MMIDD A X COMMERCIAL GENERAL LIABILITY GL06355347-07 11/01/201 11/01/2017 EACH OCCURRENCE $1,000,000 General Liability DAMAGE TO RENTED CLAIMS-MADE I X I OCCUR PREMISES(Ea occurrence) $300,000 MED EXP(Any one person) $10,000 PERSONAL 8ADV INJURY $1,000,000 2 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 m 0 OTHER 0 A AUTOMOBILE LIABILITY BAP6355348-07 11/01/2016 11/01/2017 COMBINED SINGLE LIMIT S1,000,000 o Automobile (Ea accident) ,, X ANY AUTO BODILY INJURY(Per person) 0 Z OWNED SCHEDULED BODILY INJURY(Per accident) III AUTOS ONLY AUTOS - PROPERTY DAMAGE CO X HIRED AUTOS X NON-OWNED C.)ONLY _AUTOS ONLY (Per accident) t a B X UMBRELLA LIAB X OCCUR 1000023151 11/01/2016 11/01/2017 EACH OCCURRENCE $10,000,000 Cl umbrella AGGREGATE $10,000,000 EXCESS LIAB CLAIMS-MADE DED RETENTION A WORKERS COMPENSATION AND WC6355349-07 11/01/2016 11/01/2017 X MI I IOTH- EMPLOYERS'LIABILITY y/N workers Comp STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 8500,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 II yes.descnbe under - - - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000— I® DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) a i RE: AHERN JOB #223729 - ANNUAL EXCAVATION WORK IN THE RIGHT OF WAY LICENSE, CITY OF OSHKOSH. ADDITIONAL INSURED ON A PRIMARY AND NON-CONTRIBUTORY BASIS ON THE GENERAL LIABILITY, AUTO AND UMBRELLA CITY OF OSHKOSH, AND ITS OFFICERS, COUNCIL MEMBERS, AGENTS, EMPLOYEES AND AUTHORIZED VOLUNTEERS AS RESPECTS TO THE PROJECT NAMED ABOVE PER BLANKET ADDITIONAL INSURED ENDORSEMENT, Y1 AS REQUIRED BY WRITTEN CONTRACT. ENDORSED POLICIES WILL INCLUDE A 30 DAY NOTICE OF CANCELLATION/NONRENEWAL FOR ANY REASON OTHER Y� THAN NONPAYMENT OF PREMIUM, PROVIDED TO THOSE PARTIES INDICATED IN THE WRITTEN CONTRACT. --F- CERTIFICATE HOLDER LWFV- 4ANCELLATION JUL 21 2017 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. CITY OF OSHKOSH @F1C4l COTS CHURCH AVENUE VII CITY CLERK'S©I' HORLZED REPRESENTATIVE OSHKOSH WI 54901 USA elle c 52. W ILP ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD