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HomeMy WebLinkAboutSecurity-Luebke Roofing Inc 5-1-18 ACo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 9/15/2017 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 NAMEACT Tiffanie Courtney M3 Insurance Solutions, Inc. PHONE 920-405-9162 FAX 920 405 9169 480 Pilgrim Way, Suite 1230 (HMCo.Est)• UUC.No): Green Bay WI 54304 ADDRESS:tiffanie.courtney@m3ins.com INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:Acuity Insurance Company 14184 INSURED SECUL-1 INSURERB:West Bend Mutual Insurance 15350 Security-Luebke Roofing, Inc. INSURER C: 2251 Progress Way Kaukauna WI 54130 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 1565347199 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-SUER POLICY EFF POLICY EXP LIMITS LTRINSD WVD POLICY NUMBER IMM/DD/YYYY) (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABIUTY Z19700 5/1/2017 5/1/2018 EACH OCCURRENCE $1,000,000 DAMAGE CLAIMS-MADE X OCCUR PREMISESO(EaENTED occurrrence) $250,000 MED EXP(Any one person) $10,000 PERSONALS ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY X PR0. X LOC PRODUCTS-COMP/OPAGG $3,000,000 OTHER: $ A AUTOMOBILE LIABILITY Z19700 5/1/2017 5/1/2018 COMBINED SINGLE LIMIT S (Ea accident) 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAZ'iE $ X AUTOS ONLY X AUTOS ONLY (Per accident) $ A X UMBRELLA LIAB X OCCUR Z19700 5/1/2017 5/1/2018 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$0 E B WORKERS COMPENSATION 1857752 5/1/2017 5/1/2018 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER V!N ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA E.L.EACH ACCIDENT 5100,000 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 A Leased/Rented Equipment Z19700 5/1/2017 5/1/2018 Leased/Rented Equip 150,000 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space I f required) RECEIVED The City of Oshkosh and its officers, council members, agents, employees and authorized volunte rs are Is e as adaitioryal i isureds with respect to general liability and auto liability per the policy forms, conditions and exclusions. O C T 0 4 2017 • 30 day Notice of Cancellation is included. CITY CLERK'S OFFICE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1130 Oshkosh WI 54903-1130 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD