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HomeMy WebLinkAboutPioneer Roofing LLC 5-1-18I A�o® CERTIFICATE OF LIABILITY INSURANCE GATE(MM/DD/YYYY) 4/27/2017 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 Linda Famularo NAME: R&R Insurance Services Inc PHONE A/C.No,EXtJ: (262)953-7227 FAX (A/C, (262)953-1325 1581 E Racine Avenue E-MAIL ADDRESS:linda.famularo@rrina.com PO Box 1610 INSURER(S)AFFORDING COVERAGE NAIC N Waukesha WI 53187-1610 INSURER A:West Bend Mutual Ins. Co. 15350 INSURED INsuRERB:Argent- A Division of West Bend Pioneer Roofing LLC INSURER C: PO Box 277 INSURER D: INSURER E: Johnson Creek WI 53038-0277 INSURERF: COVERAGES CERTIFICATE NUMBER:17/18 Certs 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 I 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 EFF POLICY EXP LIMITS LTR INSO WVD POLICY NUMBER (MMIDD/YYYY) (M D/M/DYYYY) X COMMERCIAL GENERAL LIABILITY 1852626 EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED A CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 200,000 5/1/2017 5/1/2018 MED EXP(Any one person) $ 10,000 WB100GL(0414) Blkt AI/PNC PERSONAL8.ADVINJURY $ 1,000,000 1 GEN'L AGGREGATE LIMIT APPLIES PER: CG2404(0509) Blkt WOS GENERAL AGGREGATE $ 2,000,000 POLICY X 12ei LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Pollution Liability $ 100,000 AUTOMOBILE LIABILITY 1852626 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO CA20482(0299) Blkt AI PNC BODILY INJURY(Per person) $ ALL OWNED SCHEDULED CA0444(0310I Blkt WOS 5/1/2017 5/1/2018 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) $ $ •X UMBRELLA LIAB X OCCUR 1852626 EACH OCCURRENCE $ 10,000,000 A EXCESS LIAB CLAIMS-MADE WB2518 Blkt AI/PNC - WI AGGREGATE $ 10,000,000 DED X RETENTION$ 0 Projects only 5/1/2017 5/1/2018 $ WORKERS COMPENSATION X PER 0TH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A B (Mandatory in NH) 1851925 5/1/2017 5/1/2018 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION vF OPERATIONS below E.L.DSEASE-POLICY LIMIT $ 1,000,000 A Leased/Rented Equipment 1852626 5/1/2017 5/1/2018 $200,000Limit Installation Floater $150,000Limit DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) RECEIVED MAY 01 2017 — CITY r>I FY2K'S OFFICE 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 Attn: City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Avenue PO Box 1130 AUTHORIZED REPRESENTATIVE Oshkosh, WI 54903-1130 �� " Brad Stehno/C220 _- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2o1ao1)