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HomeMy WebLinkAboutSMA Construction Services LLC 12-31-18 AcoR_ CP CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD""") �� 12/19/2017 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 NAME: COnnle Campbell Bay Insurance Agency, Inc. lac No.Extl: (920)339-8262 FAX No): (920)339-8294 3136 Holmgren Way, P.O. Box 28077 ADDRESS: ccampbell@bayinsagency.com Green Bay,WI 54324-0077 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Society Insurance 15261 INSURED INSURERS: Society Insurance Company SMA Construction Services LLC Stephanie Abhold INSURER C: 201 W Walnut St Ste 301 INSURER D: Green Bay, WI 54303 INSURER E: - INSURER F: COVERAGES CERTIFICATE NUMBER: 00000000-1907129 REVISION NUMBER: 76 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 LTR ANSD DDL WVD POLICY NUMBER IMM/DD/WYYI IMM/DD/YYYY) TYPE OF INSURANCE LIMITS A X COMMERCIAL GENERAL LIABILITY Y CRC 559071 12/31/2017 12/31/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 X ISO Form CG 20 37 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JEI r LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ COMIND A AUTOMOBILE LIABILITY Y CAP 532666 12131/2017 12/31/2018 (Ea accidentSINGLE LIMIT $ 1,000,000 X ANY AUTO I BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X AUTOS ONLY X AUUTOCrNLYY PROPERTY(Per accident DAMAGE $ X Owned Private PX5 Owned Autos 0/T Prl $ A X UMBRELLA LIAB X OCCUR UXL 532668 12/31/2017 12/31/2018 EACH OCCURRENCE a 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATION PERTUTE I I OERTH- A STA WC 532667 12/31/2017 12/31/2018 X AND EMPLOYERS'LIABILITY Y/N _ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N N I A (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 B Errors and Omissions CRC559071 12/31/2017 12/31/2018 10,000 1 1 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Additioal insured per attached endoresments. Certificates of insurance acceptable to the City of Oshkosh shall be submitted prior to commencement of the work to the applicable City department. These certificates shall contain a provision that coverage afforded under the policies will not be cancelled or non renewed until at least a 30 days' prior writen notice has been given to the City Clerk-City of Oshkosh. ____. ..7____pip;_cmcivE,0 CERTIFICATE HOLDER DEC 1 2017 CANCELLATION City of Oshkosh, Attn: i 1t,ERltlS OFFICE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 215 Church Avenue ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1130 AUTHORIZED REPR TATIVE Oshkosh,WI 54903-1130 >Uru� (CMC) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by CMC on December 19,2017 at 03:18PM