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HomeMy WebLinkAboutOn-Site Environmental Services Inc 1-20-18 AM CERTIFICATE OF LIABILITY INSURANCE DATE IMMID D/YYYY) `---- 8/24/2017 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 an ADDITIONAL INSURED, the policy(ies) must 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 Beck Keitel, CIC NAME: Y Keitel Group Insurance, Inc PHONE (608)244-1146 FAX (600244-2640 tA/C.No.Exu: INC,Nol: 3880 Steven Drive E-MAIL ADDRESS: - 7 INSURER(S)AFFORDING COVERAGE _ NAIC i DeForest WI 53532 INSURER A:We El t Band 15350 INSURED INSURER B Admiral Insurance Company On-Site Environmental Services, Inc INSURERC: PO Box 280 INSURERD: — — — INSURER E: Sun Prairie WI 53590 INSURER F- COVERAGES CERTIFICATE NUMBER:Master 2017-2018 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. INSR )ADDL'SUBRi- ' POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD'. POLICY NUMBER ( DJYYYY) (MM/DD/YYYY)i LIMITS X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE $ A CLAIMS-MADE X OCCUR ID—AMAGE TO RENTED 100,000 PREMISESLEa occurrence) $ -_ X Y 0253456 1/20/2017 1/20/2018 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 X POLICY' 7 PRO- - — -- 1 JECT L_ LOG PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER' Bodily injury limit(s) $ AUTOMOBILE LIABILITY CO aBINED SINGLE LIMIT '$ 1,000,000 (EaA X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 0253456 1/20/2017 1/20/201S BODILY $ _ AUTOS AUTOS _ ) NON-OWNED PROPERTY DAMAGE -- - -_- --- -- - __ HIRED AUTOS AUTOS (Per accident_ _$ Additional Interest $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 A - EXCESS LIAR i CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTIONS 0253456 1/20/2017 1/20/2018 $ WORKERS COMPENSATION PER I OTH- ' AND EMPLOYERS'LIABILITY YIN x ,STATUTE 1 ER ANY PROPRIETOR/PARTNER/EXECUTIVE - E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ,` N/A A (Mandatory In NH) 0253457 1/20/2017 1/20/2010 E.L.DISEASE•EA EMPLOYE$ 1,000,000 II yes,describe under -- ----- - - - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 B Pollution Liability FEIECC10929 11/30/2016111/S0/2017 2,000,000 B Professional Liability FEIECC10929 11/30/2016 111/30/2017 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Oshkosh is additional insured on a primary and non contributory basis with waiver of subrogation. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 Church Ave ACCORDANCE WITH THE POLICY PROVISIONS. Oshkosh, WI 54903 AUTHORIZED REPRESENTATIVE Becky Keitel, CIC/MC ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2014o1)