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HomeMy WebLinkAboutM&E Construction LLC 4-16-18 TE A�QREP CERTIFICATE OF LIABILITY INSURANCE DA04/17/2017Y) 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 Darren Van Camp Family Insurance Center LLC PHONE FAX N4006 Cty Rd E Ste 2B IA/C.No.Extl: 920-788-4800 (NC,No): 920-788-4801 Freedom,Wi 54913 ADORIEss: Chelsey@familyinsctr.com INSURER(S)AFFORDING COVERAGE NAIC H INSURER A: Secure Insurance Company 22543 INSURED M&E Construction LLC INSURER B: N3748 Uni Dr Freedom,WI 54130 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. ILTRR TYPE OF INSURANCE INSD SR DDL VUBR WD POLICY NUMBER M/POLICY EFF POLICY EXP LIMITS (MMlDD1YYYY1 (MDDlYYYY) A Y COMMERCIAL GENERAL LIABILITY TC3149347 04/16/2017 04/16/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED 100,000 — PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 VIPOLICY JECT PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY A3162066 04/16/2017 04/16/2018 COMaaccidBINEDent)SINGLE LIMIT $ 1,000,000 (E ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY V AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ V AUTOS ONLY V AUTOS ONLY Per accident $ A J UMBRELLA LIAB OCCUR CU3180714 04/16/2017 04/16/2018 EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 VDED RETENTION$ 10,000 $ A WORKERS COMPENSATION WC3237033 04/16/2017 04/16/2018 V STATUTE ER H- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? Y NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 j If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Additional Insured-City of Oshkosh and its officers,council members,agents,employees and authorized volunteers shall be additional insureds. CERTIFICATE HOLDER CANCELLATION i �eE _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Oshkosh APR 21 ZU1 ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1130 Oshkosh,WI 54903 AUTHORIZED REPRESENTATIVE "1,re ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD