HomeMy WebLinkAboutProfessional Concrete Raising Inc 6-1-18 07/20/2017 11: 42 19206827799 ANSAY PAGE 01/01
ACC CERTIFICATE OF LIABILITY INSURANCE 7/2az�MIOD'Yrr''
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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 POUCIES
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 endorsementfs)- _
PRODUCER CONTACT
NAME: Jean Hynek Ansay&Associates, LLC. PHONE
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920-370-4287 FAAxc, _No): 920-682-7799
4712 Expo Drive E-MAIL Jean.H ek ansa Manitowoc WI 54220 ADDRESS yn @ y.com
INSURER(S)Ar,ORDINO COVERAOE NAIC>M
INSURER A:Secura Insurance A Mutual Company 22543
INSURED PROFCON-03 INSURER B:
Professional Concrete Raising Inc INSURER C: _
NJ 9656 Darboy Drive INSURER
Appleton WI 54915
INSURER E:
INSURER F: _
COVERAGES CERTIFICATE NUMBER:926139392 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLJCY 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.
INS AlIUrdUbti POLICY EFF POLICY EXP
LTRR TYPE OF INSURANCE INSD MO POLICY NUMBER JMM/DD/YYYYL(MM/DD/YYYYL UMUS
A x COMMERCIAL GENERAL LIABILITY Y TC326919B 6/1/2017 6/1/2018 EACH OCCURRENCE 81,000,000
I
CLAIMS-MADE X OCCUR DAMAGE TO-R_ENTED .
PREMISES(Ea oca neural $100,000
MED EXP{Any one person) $5,000
PERSONAL a ADV INJURY $1,000,000
GENT AGGREGATE LIMIT APPUESPER: GENERAL AGGREGATE $2,000,000
POLICY)JECT LOC
PRODUCTS-COMProP AGO 32,000,000
OTHER
$
A AUTOMOBILE UABILRY Y A3269200 6/1/2017 6/112018----"-L'L5 INEU biNis LIMIT
X ANY AUTO (Ea accident) 1,OD0,000
BODILY INJURY(Per p¢rsan) $
tr8INNEO SCHEDULED
A unn AUTOS BODILY INJURY(Per accdent}) $
X HIRED AUTOS X AUTO-08WNED PROPERTYpAMAr3E $
(Per accident) - -
_ $
a
UMBRELLA LIAR — OCCUR EACH OCCURRENCE $
EXCESS LIAO CLAIMS-MADE
AGGREGATE $
DEDJ [RETENTIONS *
WORKERS COMPENSAYION PER OTH-
I AND EMPLOYERS'LIABILITY Y/N STATUTE ER
n E.L EACH ACCIDENT
ANY PROPRIETOR/PARTNER/EXECUTIVE $
OFFICER/MEMBER EXCLUDED? N/A
{Mandatory In NHI
f yes,deacnDe under E.L DISEASE-EA EMPLOYEE $
DESCRIPTION OF OPERATIONS blow E.L DISEASE-POLICY LIMIT S
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional it' e_ 1.i i
Remarks$ch¢dul¢,moy be attached if more space Is required) A• -
Ju� S 0 aol?
it_
et1117 CI'
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Oshkosh&its officers, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
council members,agents,employees ACCORDANCE WITH THE POUCY PROVISIONS.
&authorized volunteers
PO Box 1130
Oshkosh WI 54903-1130 AUTHORIZED REPRESENTATIVE
I Z(*A" ,/ell MA-
11988-2014 ACORD CORPORATION. All rights reserved.
ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD