HomeMy WebLinkAboutJim Fischer Inc 3-31-18 '`�`� ® CERTIFICATE OF LIABILITY INSURANCE DATE02/06/D/YYYY)
2/06/2017
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: CLIENT CONTACT CENTER
FEDERATED MUTUAL INSURANCE COMPANY PHONE
HOME OFFICE: P.O. BOX 328 (A/C,No,Eat):888-333-4949 FAX
No):507-446-4664
OWATONNA, MN 55060 ADD E-MAIL
INSURERIS)AFFORDING COVERAGE NAIC#
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED 386-341-2 INSURER B:
JIM FISCHER INC INSURER C:
2635 S CASALOMA DR
APPLETON,WI 54914 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:20 REVISION NUMBER:0
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 INSR WVD (MMIOD/YYYY) (MM/DDIYYYY)
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000
DAMAGE TO RETED
CLAIMS-MADE X OCCUR PREMISES Ea oN urrrence) $100,000
MED EXP(My one person) EXCLUDED
A Y N 9324909 03/31/2017 03/31/2018 PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
POLICY PRO LOC PRODUCTS-COMPIOP AGG $2,000,000
X PRO-
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
(Ea accident)
X ANY AUTO BODILY INJURY(Per person)
ALL OWNED SCHEDULED
A AUTOS AUTOS Y N 9324909 03/31/2017 03/31/2018 BODILY INJURY(Per accident)
HIRED AUTOS NON-OWNED PROPERTY DAMAGE
AUTOS (Per accident
X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $5,000,000
A EXCESS LIAR CLAIMS-MADE N N 9324911 03/31/2017 03/31/2018 AGGREGATE $5,000,000
DED RETENTION
WORKERS COMPENSATION OTH-
X PER STATUTE ER
AND EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $500,000
A OFFICER/MEMBER EXCLUDED? NIA N 9324912 03/31/2017 03/31/2018
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $500,000
A['R � 2011
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required)
SEE ATTACHED PAGE CITY CL i1 S"F
CERTIFICATE HOLDER CANCELLATION
386-341-2 20 0
CITY OF OSHKOSH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
PO BOX 1130 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
OSHKOSH,WI 54903-1130 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
O 1988-2014 ACORD CORPORATION.All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD