HomeMy WebLinkAboutRasmussen Concrete LLC 8-31-18 CERTIFICATE OF LIABILITY INSURANCE
American Family Insurance Company ❑
American Family Mutual Insurance Company,S.I. if selection box is not checked.
6000 American Pky Madison,Wisconsin 53783-0001
Insured's Name and Address Agent's Name,Address and Phone Number(Agt./Dist.)
Rasmussen Concrete LLC Curt L Stern
2513 Fond du Lac Rd 1920 S Washburn St
Oshkosh, WI 54902 Oshkosh, WI 54904
(920)235-1776 (102/015)
This certificate is issued as a matter of information only and confers no rights upon the Certificate Holder.
This certificate does not amend,extend or alter the coverage afforded by the policies listed below.
COVERAGES
This is to certify that 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.
POLICY DATE
TYPE OF INSURANCE POLICY NUMBER EFFECTIVE EXPIRATION LIMITS OF LIABILITY
(Mo.Day,Yr) (Mo.Day.Yr)
Homeowners/ Bodily Injury and Property Damage
Mobilehomeowners Liability Each Occurrence $ ,000
Boatowners Liability Bodily Injury and Property Damage
Each Occurrence $ ,000
Personal Umbrella Liability Bodily Injury and Property Damage
Each Occurrence $ ,000
Farm Liability&Personal Liability
Each Occurrence $ ,000
Farm/Ranch Liability Farm Employer's Liability
Each Occurrence $ ,000
Statutory
Workers Compensation and Each Accident $ ,000
Employers Liability t Disease-Each Employee $ ,000
Disease-Policy Limit $ ,000
General Liability General Aggregate $ 2,000,000
0 Commercial General Products-Completed Operations Aggregate $ 2,000,000
Liability(occurrence) 48 XV7906 02 08/31/2017 08/31/2018 Personal and Advertising Injury $ 1,000,000
❑ Each Occurrence $ 1,000,000
❑ Damage to Premises Rented to You $ 100,000
Medical Expense(Any One Person) $ 10,000
Each Occurrencett $ ,000
Businessowners Liability
Aggregatett $ ,000
Liquor Liability Common Cause Limit $ ,000
Aggregate Limit $ ,000
Automobile Liability Bodily Injury-Each Person $ 250,000
El Any Auto Bodily Injury-Each Accident $ 500,000
❑ All Owned Autos
❑ Scheduled Autos 48-XV7906-01 08/31/2017 08/31/2018 Property Damage $ 100,000
❑ Hired Auto
❑ Nonowned Autos Bodily Injury and Property Damage Combined $ ,000
❑ _
Excess Liability
❑ Commercial Blanket Excess • :✓ •ence/Ag regale $ .000
Other(Miscellaneous Coverages)
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS MM 2 4 20\1
tThe individual or partners ❑Have
rS Q1wFlC1~ shown as insured elected to
Y CI E�i{ be covered under this policy ❑Have not
C11 ttProducts-Completed Operations aggregate
is equal to each occurrence limit and is
included in policy aggregate.
CERTIFICATE HOLDER'S NAME AND ADDRESS CANCELLATION
❑ Should any of the above described policies be cancelled before the expiration date
City of Oshkosh, Attn: City Clerk thereof,the company will endeavor to mail-( days)written notice to the Certificate
215 Church Avenue Holder named,but failure to mail such notice shall impose no obligation or liability of any kind
upon the company, its agents or representatives. '10 days unless different number of days
PO Box 1130 shown.
Lj This certifies coverage on the date of issue only. The above described policies are
Oshkosh, WI 54903-1130 subject to cancellation in conformity with their terms and by the laws of the state of issue.
DATE ISSUED AUTHORIZED REPRESENTATIV
05/23/2017
U-201 Ed.5/00 Stock No. 06668 Rev.7/02