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HomeMy WebLinkAboutKinas Excavating Inc 5-1-18 ACRC� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/D AE(MMID IYY Y) 11 17 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 CONTACT Elizabeth A.Bille Nolan Insurance Agency. LLC PH FAX 112 E. Main Street IA/C.ONE Ne.E.,,,,: (920)346-2241 (ac,No): (920)346-5600 PO Box 238 E-MAIL ADDRESS: Ibille@nolanins.com Brandon,WI 539190238 _ INSURER(S)AFFORDING COVERAGE NAICS _ INSURERA: WEST BEND MUTUAL INS CO 15350 INSURED Kinas Excavating,Inc. INSURER B N6205 Lawson Drive Green Lake,WI 54941 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 ADM OF INSURANCE AD SUBR POUCY EFF POUCY EXP UNITS LTR INW D VD POLICY NUMBER (MMIDO/YYYY) (MMIDD/YYYY1 A V COMMERCIAL GENERAL LIABILITY y 0956044 05/01/2017 05/01/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO 1CLAIMS-MADE 1 ✓OCCUR PREMISES(EaE n NTED occuencel $ 200,000 MED EXP(Any one person) $ 10,000 PERSONAL BADVINJURY S 1,000,000 GEN'L AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE I S 2,000,000 ;Ea LOC PRODUCTS $ 2,000,000 POUCY � OTHER: S A AUTOMOBILE LIABILITY Y 0956044 05/01/2017 05/01/2018 COMBINED SINGLE UMIT $ 1,000,000 (Ea acadenl 7 ANY AUTO BODILY INJURY(Par person) S OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Jr acodent_)_ $ A Y UMBRELLALIAB _ OCCUR 0956044 05/01/2017 05/01/2018 EACH OCCURRENCE S 6,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE S 6,000,000 DED RETENTION$ _ $ A WORKERS COMPENSATION 0956045 05/01/2017 05/01/2018 ,n PER oTH- AND EMPLOYERS'LIABILITY Y I STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N EL.EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N1A - - - -- -- --- (Mandatory in NH) E.L DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UMIT $ - 1,000,000 , i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if mom space is required) City of Oshkosh,and its officers,council members,agents,employees and authorized volunteers are additioanl insured on a primary and non-contributory basis on the general liability and auto liability.Cancellation or non-renewal 30 day prior written notice will be given to City of Oshkosh. CERTIFICATE HOLDER CANCELLATION Email:ttaylor@ci.oshkosh.wi.us ,r .'' •^'t SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE rR+ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Oshkosh A 0 ���� ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Avenue Oshkosh,WI 54901 JAIn ` THORIZED REPRESENTATIVE CLERK',UiitiC 0.4td: " �` `-';-i,� C[TY ✓ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD