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HomeMy WebLinkAboutMiron Construction Co 4-1-18 ���® DATE(3 O M/DN DYYY) y— CERTIFICATE OF LIABILITY INSURANCE O 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 tc this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). m PRODUCER CONTACT 15 NAME: Aon Risk Services Central, Inc. PHONE (920) 437-7123 FAX (920) 431-6345 .- Green Bay WI Office (A/C.No.Ert): (NC.No.): 111 N. Washington Street, Suite 300 ADDRESS: S P. 0. Box 23004 Green Bay WI 54305-3004 USA INSURERS)AFFORDING COVERAGE NAIC F INSURED INSURER A: Liberty Insurance underwriters, Inc. 19917 MIRON CONSTRUCTION CO.. INC. INSURERS: Zurich American Ins Co 16535 P. O. Box 509 Neenah WI 54957-0509 USA INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570065782782 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 INSD WVD POLICY NUMBER ((MMIDDmmvvY1 $MM/ODmrvro LIMITS B X COMMERCIAL GENERAL LIABILITY GLO 9259229-10 04701/20I7 04/01/2018 EACH OCCURRENCE S1,000,000 CLAIMS-MADE OCCUR GENERAL LIABILITY DAMAGE TO RENTED ' 5500,000 PREMISES(Ea occurrence) X CONTRACTUAL LIAB MED EXP(Any one person) S10,000 PERSONAL&ADV INJURY S1,000,000 m GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 m POLICY D PRO- El PRODUCTS-COMP/OP AGG S 2,000,000 0 JECT 0 OTHER: 0 r` B AUTOMOBILE LIABILITY BAP 9259228-10 04/01/201704/01/2018 COMBINED SINGLE LIMIT $1,000,000 m BUSINESS AUTOMOBILE (Fa accident) ,- X ANY AUTO BODILY INJURY(Per person) 0 OWNED —SCHEDULED BODILY INJURY(Per accident) W AUTOS ONLY AUTOS ry HIRED AUTOS NON-OWNED PROPERTY DAMAGE U X x ONLY —AUTOS ONLY (Pe,accident) =- a A 1001000038761-11 04/01/2017 04/01/2018 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE S lO,OOO,000 U UMBRELLA LIABILITY AGGREGATE $10,000,000 EXCESS LIAB CLAIMS-MADE DED X RETENTION S10,000 B WORKERS COMPENSATION AND WC 9259230-10 04/01/2017 04/01/2018 X PER �0TH EMPLOYERS'LIABILITY Y WORKERS' COMPENSATION FR ANY PROPRIETOR I PARTNER I EXECUTIVE E.L.EACH ACCIDENT S1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,descebe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S1,000,000— .II: Ms DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) '� RE: STREET / SIDEWALK OBSTRUCTION / SIDEWALK LAYERS / CURB CUT CONTRACTORS / EXCAVATION / WORK IN RIGHT-OF-WAY LICENSES 1� ADDITIONAL INSURED ON A PRIMARY BASIS ON THE GENERAL LIABILITY AND AUTO LIABILITY CITY OF OSHKOSH, AND ITS OFFICERS, COUNCIL MEMBERS, AGENTS, EMPLOYEES, AND AUTHORIZED VOLUNTEERS AS RESPECTS THE PROJECT NAMED ABOVE PER BLANKET ADDITIONAL INSURED ENDORSEMENT. CERTIFICATE HOLDER ��� j'WED CANCELLATION N 0$ 20i$ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Jn EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE I"� POLICY PROVISIONS. CITY OF OSHKOSH 5 OVIRCE AUTHORIZED REPRESENTATIVE �_ 215 CHURCH AVENUE ,�.Y CI,E,RK P.O. BOX 1130 CI Or OSHKOSH WI 54902-1131 . t.(4 , /��iu( , ._ . 4. mi ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD