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HomeMy WebLinkAboutPTS Contractors Inc 7-10-18 �....41 PTSCO-1 OP ID: MH ACORO- DATE(MMIDD/YYYY) ki,..-i CERTIFICATE OF LIABILITY INSURANCE 11/13/2017 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 CONTANAME CT Troy Carlson McGlone PHONE 920-725-3232 FAX 150 Main Street,Ste 300 (A/C No,Ertl: lac,No):920-725-3233 Menasha,WI 54952-0389 ADDRESS:troy.carlSon@mcclone.com Troy Carlson INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Sentry Insurance a Mutual Co 24988 INSURED PTS Contractors Inc INSURER B: 4075 Eaton Road Green Bay,WI 54311 INSURER c: INSURER 0: 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 SUER ' POLICY EFF POLICY EXP LT TYPE OF INSURANCE INSD YY LIMITS LTR INSD VD POLICY NUMBER �'(MM/DDIYYYY) (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY j EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X OCCUR X A0083395005 07/10/2017 07/10/2018 DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE a 3,000,000 POLICY X PRO- X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO X A0083395001 07/10/2017 07/10/2018 BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) a X UMBRELLA UAB X OCCUR I EACH OCCURRENCE $ 8,000,000 A EXCESS LIAB CLAIMS-MADE X A0083395007 07/10/2017 07/10/2018 AGGREGATE $ 8,000,000 DED X j RETENTIONS 0 S WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y N NIA A0083395006 07/10/2017 07/10/2018 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-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is requir RE1'*E TO Re: 2018 Bonds/Insurance 11.• In regards to work performed by the insured, the City of Oshkosh, and it's officers council members,agents,employees and authorized volunteers are .BAN 02 20 additional insureds under the Commercial General Liability,Automobile Liability and Umbrella per policy language. — ` i�TrY CLF "--� 110E CERTIFICATE HOLDER CANCELLATION OSHCITI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF OSHKOSH ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 1130 215 CHURCH AVENUE AUTHORIZED REPRESENTATIVE OSHKOSH,WI 54903-1130 Troy Carlson ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD