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HomeMy WebLinkAboutQuality Building Restoration 3-31-18 ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYYY) 06/01/2017 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 have ADDITIONAL INSURED provisions or 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 Judy Seibel NAME: Y Charles Rafferty PHONE No.Ext1: 920-722-7303 j FAX Not: 920-832-0275 3033 W Spencer St AIL ADDRESS: assistantcrafferty@ruralins.com Appleton WI 54914 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Rural Mutual Insurance Company INSURED INSURERB: Quality Building Restoration Inc INSURERC: 3811 N Alvin St INSURERD: Appleton WI 54913 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W LIMITS LTR INSD VD POLICY NUMBER (MMIDD/YYYYI IMMIDD/YYYYI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE CLAIMS-MADE [XJ OCCUR PREM SEE aENTED occu occurrence) $ 50,000 MED EXP(Any one person) $ 5,000 A CPPG131640 03/31/2017 03/31/2018 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X'POLICY PECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: --------- $ --- AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED X AUTO SCHEDULED AUTOS ONLY BAPG131637 03/31/2017 03/31/2018 BODILY INJURY(Per accident) $ X HIRED NZ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /• AUTOS ONLY (Per accident) X UMBRELLA LIAB OCCUR ` EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE CPPG131640 03/31/2017 03/31/2018 AGGREGATE $ DED RETENTION$ $WORKERS COMPENSATION X STATUTE EOT RH AND EMPLOYERS'LIABILITY - A OFFICERMEMBERE C UDED?ANYPROPRIETOR/PARTNERJEXECUTIVE YNN N/A WRKG131568 03/31/2017 03/31/2018 .E.LEACH ACCIDENT $ 100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,descnbe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) IRLj'C JUN0` 2D17 CITY CLERWSVISVICE CERTIFICATE HOLDER CANCELLATION 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. Attn: City Clerk AUTHORIZED REPRESENTATIVE !_. —�_ ch Ave JL� V ✓ (05_) Oshkosh WI 54903 Z���{ � ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD