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HomeMy WebLinkAboutKS Energy Services LLC 10-30-18 ® DATE(MM/DD/YYYY) OE ACR CERTIFICATE OF LIABILITY INSURANCE 10/20/2017 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 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Risk Strategies Company NAMEACT 160 Federal St. 2nd Floor PHONE FAX Boston, MA 02110 (A/C.IL Ext):E4AA 617-330-5700 (NC,No): 617-439-3752 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# _ INSURER A: XL/Greenwich Insurance Company 22322 _ INSURED INSURER B: XL Insurance America Inc 24554 KS Energy Services, LLC 19705 W Lincoln Ave INSURER C: XL Specialty Insurance Company 37885 New Berlin WI 53146 INSURERD: Illinois Union Insurance Company 27960 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 38449906 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 EFF POLICY EXP LIMITS LTRW INSD VD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) A �/ COMMERCIAL GENERAL LIABILITY ✓ CGD 740935203 10/30/2017 10/30/2018 EACH OCCURRENCE $2,000,000 DAMAGE TO CLAIMS-MADE ✓ OCCUR PREMISES(EaENTED occurrence) $300,000 ✓ ind XCU&Contractual MED EXP(My one person) $5,000 Liability&RR Liability PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY ✓ J1ECT ✓ LOC PRODUCTS-COMP/OP AGG $4,000,000 OTHER: $ A AUTOMOBILE LIABILITY CAD 740935303 10/30/2017 10/30/2018 (Ee aaadEerDit?INGLE LIMIT $2,000,000 ✓ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ ✓ AUTOS ONLY ✓ AUTOS ONLY (Per accident) B ✓ UMBRELLALIAB 1/ OCCUR US00076832L117A 10/30/2017 10/30/2018 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED RETENTION$ $ C WORKERS COMPENSATION CWD 740935103/ 10/30/2017 10/30/2018 / STATUTE OTH- ER AND EMPLOYERS'LIABILITY Y/N CW R 740935003 ANYPROPRIE EREXCLUDEDXECUTIVE N N/A E.L.EACH ACCIDENT $1,000,000 OFFER/ME(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1.000.000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 D Environ Contr Pollution G46826917001 ($50K SIR) 10/30/2017 10/30/2019 Each Claim/Aggregate $10,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Oshkosh and its officers,council members,agents,employees and authorized volunteers are included as Additional Insureds as respects to General Liability as required by written contract. General Liability policy shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by Additional Insureds. CERTIFICATE HOLDER CANCELLATION City of Oshkosh SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE P.O. BOX o0 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Oshkosh WI 54902 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Michael Christian ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 38449906 100118531 117-18 GLALEXWCPOL (KSE) I Patra 110/20/2017 8,34:43 AM (EDT) 1 Page 1 of 1