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HomeMy WebLinkAboutJeff Foust Excavating Inc 4-1-18 ___....--.41 FOUST-1 OP ID: RG ,A�ORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/17/2016 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 McClone-Oshkosh NAME: Brian McClone 505 North Westfield Street A/CC,,"No,Ext):920-233-4000 FAX No):920-233-2728 Oshkosh,WI 54902-4105 ADD ESS:brian.mcclone@mcclone.com Brian McClone INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:United Fire&Casualty Co 13021 INSURED Jeff Foust Excavating Inc. INSURER B: 2824 Clairville Rd. Oshkosh,WI 54904 INSURER C: 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 ADDL SUER POLICY EFF POLICY EXP -- LTR INSD WVD POLICY NUMBER A X COMMERCIAL GENERAL LIABILITY IMM/DD/YYYY) NM/DO/NWT) LIMITS - EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X 160473986 04/01/2017 04/01/2018 DAMAGE-SrO RENTED PREMISE (Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 X Aggr Per Proj CG7 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER Emp Ben. $ 1/2000000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 A X ANY AUTO X 60473986 04/01/2017 04/01/2018 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS-MADE X '60473986 04/01/2017 04/01/2018 AGGREGATE $ 2,000,000 DED X l RETENTION$ 10000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y!N X STATUTE ER A ANY PROPRIETOR/PARTNERfEXECUTIVE 60473986 04/01/2017 04/01/2018 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED/ N/A (Mandatory in NH) If yes.describe under E.L.DISEASE-EA EMPLOYEE $ 500,000 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) n L''C I`/ City of Oshkosh, its officers, council members, agents, employees and L�ri`L-aJ authorized volunteers are Additional Insured on a Primary and Non Contributory Basis with respects to General Liability including Ongoing and APR 0 7 2017 Completed Operations when required by written contract per forms CG7201 and j IL7105; and Additional Insured with respect to Auto Liability on a (cont) CITY CL..W:2S(yl't'iC CERTIFICATE HOLDER CANCELLATION OSHCI-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Oshkosh ACCORDANCE WITH THE POLICY PROVISIONS. Attn: City Clerk 215 Church Avenue AUTHORIZED REPRESENTATIVE PO Box 1130 5 _4,i —,_ iOshkosh,WI 54903-1130 v ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD