Loading...
HomeMy WebLinkAboutPrecision Concrete Floors Inc 6-21-18 PRECI-6 OP ID: NK a►coRo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDlVYVV) 04/09/2018 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 CONTNAME:ACT PATRICK A HEURING ADEMINO&ASSOCIATES INC DAVID ADEMINO (iAJC No,Eat):920-734-3110 FAX No): 920-734-6027 1001 TRUMAN P 0 BOX 99 E-MAIL ADDRESS:P heuring@ ademino.com KIMBERLY,WI 54136-0099 PATRICK A.HEURING INSURER(S)AFFORDING COVERAGE NAIL INSURER A:FRANKENMUTH MUTUAL INSURANCE 13986 INSURED PRECISION CONCRETE FLOORS INC INSURER B: ERIC PALMQUIST INSURER c: 3129 CUTTER CT OSHKOSH,WI 54904 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 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 LTR IADOL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE INSD WVD (MMIDD!YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE a 1,000,000 CLAIMS-MADE X OCCUR X BOP 6363996 06/21/2017 06/21/2018 DAMAGE TORENFED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENII_AGGREGATE LIMIT APPUES PER GENERAL AGGREGATE a 2,000,000 POUCY X JE% f X J LOC PRODUCTS-COMP/OP AGG a 2,000,000 OTHER AUTOMOBILE LIABILITY COMBBIINdED1SINGLE LIMIT $ 1,000,000 (Ea aA ANY AUTO X BA 6363996 06/21/2017 06/21/2018 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE a AUTOS (Per accident) • X UMBRELLA LIAR X OCCUR EACH OCCURRENCE a 5,000,000 A EXCESS LIAB CLAIMS-MADE BOP 636996 06/21/2017 06/21/2018 AGGREGATE a 5,000,000 DED X RETENTION S 0 a WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y A ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA WC 6363996 06/21/2017 06/21/2018 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCY OMIT $ 500,000 r DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule.may be attached if more space is required) Ma I V 0 4 2018 I THE CITY OF OSHKOSH,ITS EMPLOYEES AND OFFICERS,ARE AN ADDITIONAL INSURED �l WITH REGARD TO GENERAL LIABILITY AND AUTOMOBILE LIABILITY C11 TCE CERTIFICATE HOLDER CANCELLATION OSCIT-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF OSHKOSH THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ATTN: INSURANCE DEPT 215 CHURCH ST AUTHORIZED REPRESENTATIVE OSHKOSH,WI 54901 gy m/ o- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD