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HomeMy WebLinkAboutMCC Inc 8-1-18 MM/ Acote L7l DAT 0 7/2 112 01 7YYV) CERTIFICATE OF LIABILITY INSURANCE 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 ,°i=- this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). .c CONTACT 0 PRODUCER — NAME: Aon Risk Services Central, Inc. (NC.No.ExIl.PHONE (920) 437-7123 (NC No.): (920) 431-6345 'G Green Bay WI office 111 N. Washington Street, Suite 300 E-MAIL o P. 0. Box 23004 ADDRESS: _ Green Bay WI S4305-3004 USA INSURER(S)AFFORDING COVERAGE NAIC# -INSURED INSURER A: ACUITY, A Mutual Insurance Company 14184 MCC, Inc. INSURER B: P O Box 1137 Appleton WI 54912 USA INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570067617048 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 INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER (MMIDDIYYYY1 IMMIODIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 750532 08/01/2017 08/01/2018 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR GENERAL LIABILITY DAMAGEIO RENTED $250,000 PREMISES(Ea occurrence) X Contractual Dab MED EXP(Any one person) S10,000 PERSONAL ADV INJURY $1,000,000 v GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 N- POLICY I JE a I X I LOC PRODUCTS-COMP/OP AGG S2,000.000 0 OTHER 0 A AUTOMOBILE LIABILITY 750532 08/01/2017 08/01/2018 COMBINED SINGLE LIMIT $1,000,000 t BUSINESS AUTOMOBILE (Ea accident) X ANY AUTO BODILY INJURY(Per person) 0 Z OWNED SCHEDULED BODILY INJURY(Per accident) 0 AUTOS ONLY AUTOS X HIRED AUTOS x NON-OWNED PROPERTY DAMAGE U ONLY AUTOS ONLY (Per accident) Or A X UMBRELLALIAB X OCCUR 750532 08/01/2017 08/01/2018 EACH OCCURRENCE $10,000,000 V UMBRELLA LIABILITY AGGREGATE $10,000,000 EXCESS LIAB CLAIMS-MADE DEDI RETENTION A WORKERS COMPENSATION AND 750532 08/01/2017 08/01/2018 X STATUTEPER I0TH EMPLOYERS'LIABILITY YIN WORKERS COMPENSATION ANY PROPRIETOR/PARTNER/EXECUTIVE ri E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED, N 1 A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes deccrihe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000— AL INN Aim DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) _1 ADDITIONAL INSURED ON A PRIMARY AND NON-CONTRIBUTORY BASIS ON THE GENERAL LIABILITY AND AUTO CITY OF OSHKOSH, ITS OFFICERS, 11 COUNCIL MEMBERS, AGENTS, EMPLOYEES OR AUTHORIZED VOLUNTEERS AS RESPECTS TO THE WORK BEING DONE PER BLANKET ADDITIONAL INSURED .!-_ ENDORSEMENT, AS REQUIRED BY WRITTEN CONTRACT. ENDORSED POLICIES WILL INCLUDE A 30 DAY NOTICE OF CANCELLATION/NONRENEWAL FOR ANY nFl REASON OTHER THAN NONPAYMENT OF PREMIUM, PROVIDED TO THOSE PARTIES INDICATED IN THE WRITTEN CONTRACT. H tt+- CERTIFICATE HOLDER C\_ lFCE1\ EP_. CANCELLATION ni SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE JUL $4 2017 1 EXPIRATION DATE THEREOF, NOTICE WLL BE DELIVERED IN ACCORDANCE WITH THE II POLICY PROVISIONS. --1 CITY OF OSHKOSH AUTHORIZED REPRESENTATIVE My PO BOXATTN: CITY 1130CLERK CITY CLOCK'S E �R OSHKOSH WI 54903 USA /yam ` _ Tr$ —e O�n� M Ley �,�G (, 1-6 ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD