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HomeMy WebLinkAboutM.J. Electric LLC 5-1-18 TMM/DD/ ACc DATE( YYYY) RCY CERTIFICATE OF LIABILITY INSURANCE ; I ,(,l , MMioor 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 LOCKTON COMPANIES CONTACT 5847 SAN FELIPE,SUITE 320 PHONE Ext): (A/C No): HOUSTON TX 77057 E-MAIL 866-260-3538 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Old Republic Insurance Company 24147 INSURED M.J.ELECTRIC,LLC INSURER B: ACE Property&Casualty Insurance Co 20699 1380395 A QUANTA SERVICES COMPANY INSURER C 200 W.FRANK PIPP DRIVE IRON MOUNTAIN MI 49801 INSURER D: INSURER E: INSURER F: COVERAGES MJSEROI CERTIFICATE NUMBER: 14491996 REVISION NUMBER: XXXXXXX 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRINSD WVD (MM/DD/YYYY)(MM/DDIYYYY) A x COMMERCIAL GENERAL LIABILITY Y N MWZY 310349 5/1/2017 5/1/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAPREMISESO(Ea occurrence) $ 1,000,000 MED EXP(Any one person) $ Excluded PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 I POLICY X JERT OTHER LOC PRODUCTS-COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY Y N MWTB 310348 5/1/2017 5/1/2018 COMBINED(Eaaocldent) SINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX X ONLY -SCHEDULED BODILY INJURY(Per accident $ XXXXXXX X HAIREDUTOS ONLY X AUT NON OS OWNONLY ED PROPERTY DAMAGE (Per accident) $ XXXXXXX $ XXXXXXX II X UMBRELLA LIAB X OCCUR Y N X00 G27972032 002 5/1/2017 5/1/2018 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ $ XXXXXXX WORKERS COMPENSATION A AND EMPLOYERS'LIABILITY Y/N N MWC 310350 00 5/1/2017 5/1/2018 X STATUTE DER ANY AFYIPROPRIE ER PARTNERS ECUTIVE �, N/A E L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) E L.DISEASE-EA EMPLOYEE $ 1,000,000 I/yes describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re: Annual Excavation/Work in Right-of-Way License/Permit. Additional Insured in favor of City of Oshkosh(on all policies except Workers' Comp/EL)where and to the extent required by written contract.30 days notice of cancellation is included on the policies. CERTIFICATE HOLDER �! �i CANCELLATION See Attachments 1ECEIV yJ� -, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN AP+ 4 �0�� ACCORDANCE WITH THE POLICY PROVISIONS. /4491996 _ I_\ __ AUTHORIZED REPRESENTATIVE City of Oshkosh CITY CLERKis OFFICE , Attn:City Clerk 215 Church Avenue PO Box 1130 OshKosh WI 54903-1130 --4- ACORD 25(2016/03) ©1988-2015 ACORD CORPORATI• All rights reserved The ACORD name and logo are registered marks of ACORD