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HomeMy WebLinkAboutJ Harvey Contracting LLC 5-1-18 JHARVEY-01 MWOLF ,4c-oRO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 05/10/2017 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 ACT The Diedrich Agency A/C,No,Ext (920)232-4090 I FAX No):(920)748-5044 303 High Avenue E�M Oshkosh,WI 54902 MAASS: INSURER(S)AFFORDING COVERAGE NAIC>< INSURER A:Acuity 14184 INSURED INSURER B: J Harvey Contracting LLC INSURER C: 2220 Springbrook Road INSURER D: Omro,WI 54963 - 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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DD/YYYY1 IMMIDD!YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE E 1,000,000 CLAIMS-MADE X OCCUR Z44745 05/01/2017 05/01/2018 DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) E _ MED EXP(Any one person) E 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE E 2,000,000 POLICY LOC I PRODUCTS-COMP/OP AGG S 2,000,000 OTHER VOLUNTARY PROPE E 2,500 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident X ANY AUTO Z44745 05/01/2017 05/01/2018 BODILY INJURY(Per person) E OWNED SCHEDULED AUTOS ONLY _ AUTOS yyN p BODILY INJURY(Per accdent E HIREDTO ONLY AUTOS ONLY (Peracciid PROPERTY ) E A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE E 1,000,000 EXCESS LAB CLAIMS-MADE Z44745 05/01/2017 05/01/2018 AGGREGATE E DED X RETENTIONS 0 A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN Z44745 05/01/2017 05/01/2018 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ pFFICER/ME M R EXCLUDED? Y N/A (Mlandatory In NH) E.L.DISEASE-EA EMPLOYE q S 100,000 _ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below _ I E.L.DISEASE-POLICY LIMIT S I �I DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Jarrod Harvey is excluded under the workers compensation policy. RECEII�PD ~'1 MAY 14 2017 cr;y cl- cRKr SoF• cE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CityACCORDANCE WITH THE POLICY PROVISIONS. Attn City Clerks Office PO Box 1130 Oshkosh,WI 54903 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD