HomeMy WebLinkAboutMartell Construction Inc 2-1-18 _---mml m OATE(MMIDDIYYYY)
A _R� CERTIFICATE OF LIABILITY INSURANCE
01/16/2017
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 en ADDITIONAL INSURED,the policy(les)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 IC
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). c
PRODUCER CONTACT L
NAME: s
Aon Risk Services Central, Inc. PHONE (620) 437-7123 FAX (920) 431-6345 6-1Green Ray WI Office (A/C.No.Est): (NC.No.): 10
111 N. Washington Street, Suite 300 E-MAIL -8
P. 0. Box 23004 ADDRESS'
Green say WI 54305-3004 USA
INSURER(S)AFFORDING COVERAGE NAIC Y
INSURED INSURER A ACUITY, A Mutual Insurance Company 14184
Martell construction Inc. INSURER B:
1220 Hurlbut Street
Green Bay WI 54303 USA INSURER C;
INSURER D.
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:570065286836 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. Limits shown are as requested
USSR MR SDBR POLICY EFF POL1CY6XP
6,TtR TYPE OF INSURANCE 1NSP WVp POLICY NUMBER ((MMtOp ��1I�1,wrPDIYYYVI LIMITS
A X COMMERCIAL GENERAL LIABILITY L54414 02/01/2017 02/01/2018 EACH OCCURRENCE S1,000,000
I--I General Liability DAMAGE TO RENTED $250,000
CLAMS-MADE I I OCCUR PREMISES(Ea occurrence)
11 MED EXP(My one person) S10,000
---
PERSONAL&ADV INJURY S1,000,000 E
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S3,000,000 2
1 POLICY 111 JECT X�LOC PRODUCTS.COMPrOP AGO S3,000.000 Co
o
OTHER n
A AUTOMOBILE LIABILITY L54414 02/01/2017 02/01/2018 COMBINED SINGLE LIMIT S1,000,000 w
Auto Liability (Ea accident) „
X ANY AUTO BODILY INJURY(Per person) _
— OWNED —SCHEDULED BODILY INJURY(Per ecddonl) m
AUTOS ONLY AUTOS 10
X HIRED AUTOS X NON•OWNED PROPERTY DAMAGE O
ONLY _AUTOS ONLY (Per accident)
a
A x UMBRELLALIAR 'X OCCUR •L54414 02/01/2017 02/01/2018 EACH OCCURRENCE S6,000,000 ()
Umbrella AGGREGATE $6,000,000
EXCESS UAB CLAIMS-MADE
DEO' 'RETENTION
A WORKERS COMPENSATION AND L54414 02/01/201T 02/01/2018 )( PER
0TH
EMPLOYERS'LIABIUTY YIN Workers Compensation
ER
ANY PROPRIETOR'PARTNER 7 EXECUTIVE E.L.EACH ACCIDENT S1,000,000
AA OFFICEREMBER EXCLUDED? N N I A
(Mendatory In NH) E.L.DISEASE-EA EMPLOYEE S1,000,000
I!one,desaibe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S1,000,000—
2
DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(ACORD 101,Mdmonal Remarks Schedule,maybe attached If mom space Is required)
RE: SIDEWALK LICENSE. ADDITIONAL INSURED ON THE GENERAL LIABILITY AUTO AND UMBRELLA POLICIES ON A PRIMARY NONCONTRIBUTORY BASIS Z1
THE CITY OF OSHKOSH, ITS OFFICERS, COUNCIL MEMBERS, AGENTS. EMPLOYEES OR AUTHORIZED VOLUNTEERS AS RESPECTS THE WORK BEING DONE �i,�
PER BLANKET ADDITIONAL INSURED ENDORSEMENT. I "
\
I\ MAYO12Q1
CERTIFICATE HOLDER CANCELLATION i C1�1'- - �+
SHOULD ANY OF THE MOVE DESCRIBED POLICIES BE CANCELLED BEFORE TTE C
EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.
Y4.
CITY OF OSHKOSH AUTHORIZED REPRESENTATIVE
P.O. BOX 1130
OSHKOSH WI 54902 USA Or
i
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