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HomeMy WebLinkAboutL&H Gyr Excavating 8-1-18 �....N L&HGEXI OP ID: KN ACORO DATE(MM/DD/YYYY) �� • CERTIFICATE OF LIABILITY INSURANCE 11/29/2017 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 Jon Templin, CISR,CRIS Hausmann-Johnson Insurance Inc PHONE FAX 700 Regent St., PO Box 259408 (A/C.No,EM):608-257-3795 (A/c,No): 608-257-4324 Madison,WI 53725-9408 E-MAIL Jon Templin,CISR,CRIS ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Sentry Insurance 24988 INSURED L& H Gyr Excavating, Inc. INSURER B:Travelers Casualty&Surety 19038 629 Van Dyne Rd Fond du Lac,WI 54937-1448 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 2016 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. IUCY EXP LTR TYPE OF INSURANCE IANSD WVD I POLICY NUMBER (MM DDIYYYY) (DDL SUB POUCY EFF MM DDIYYYV) LIMITS A 1 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X I occuR X A0059430004 08/01/2017 08/01/2018 DAMAGETORENTED 500,000 CLAIMS-MADE PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY I X I IN LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 (Ea accident) + + A 1 X ANY AUTO — A0059430001 08/01/2017 08/01/2018 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X PROPERTY DAMAGE $ NON (Per accident) AUTOS-OWNED - $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB 'CLAIMS-MADE A0059430007 08/01/2017 08/01/2018 AGGREGATE $ 5,000,000 DED RETENTION$ 0 $ WORKERS COMPENSATION X PER OTH- 1 AND EMPLOYERS'LIABILITY STATUTE ER V A I ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A A0059430006 08/01/2017 08/01/2018 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? — — - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 1 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 B Railroad DTSPS5H776418 08/04/2017 08/04/2018 Occurence 5,000,000 Protective Aggregate 10,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) The City of Oshkosh, and its officers, council members, agents, employees RECEIVED and authorized volunteers are additional insureds under the general liabliity when required in written contract. �AN Q�+ 201$ CITY C�-E +S OFFICE CERTIFICATE HOLDER CANCELLATION CITYOSH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Office of City Clerk 215 Church Ave AUTHORIZED REPRESENTATIVE PO Box 1130 ,l Oshkosh,WI 54903-1130 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD