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HomeMy WebLinkAboutSemena's Excavation & Trucking Inc 1-1-18 A CORLY DATEIMMIDDM/YV) �� CERTIFICATE OF LIABILITY INSURANCE 08/30/2017 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 JOLENE SZUCS NAME: PHONE 920-924-3995 FAX Mo): 920-921-5834 _Mx.No.E:U: ----_. JOLENE SZUCS AGENCY EalAll SS: jszucs@ruralins.com ADDR E 101 WISCONSIN AMERICAN DRIVE SUITE 300 INSURER(S)AFFORDING COVERAGE NAB:/ FOND DU LAC WI 54937 NSURERA: RURAL MUTUAL INSURANCE COMPANY 15091 INSURED _--- INSURER B: INSURER C: SEMENA'S EXCAVATION&TRUCKING,INC INSURER o: N7406 SUNSET CIRCLE DRIVE INSURER E: FOND DU LAC WI 54937 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 AU.THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. PIER LIC TYPE OF INSURANCE ADOL SUBR - POY EFF POLICY EXP LTR INSD WVD POLICY NUMBER I MIOO(YYYY1) IMMIDWYYYYI ----- LIMITS-- COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO RENTEO .$ 1,000,000 1 CLAIMS-MADE A OCCUR (PREMISES Ea occcunsnIx) S 513•1:" MED EXP(Any one person) $ 5.000 A CPP0102724 01/01/2017 01/01/2018 I PERSONAL s ADV INJURY $ 1.000.000 GENt.AGGREGATE LIMIT APPLIES PER: i GENERAL AGGREGATE $ 2,000,000 POLICY, ] i[-OT ( 1 LOC _PRODUCTS-COMP/OPAGG S 2.000,000 OTHER. I S AUTOMOBILE LIABILITY I r COMBINED SINGLE LIMIT S 1,000,000 (Ea acadent)ANY AUTO BODILY INJURY(Per person) S 10,000 - OWNED v I SCHEDULED A , AUTOS ONLY ,X AUTOS BAP2224493 01/01/2017 01/01/2018 BODILY INJURY(Per accident) S �/ HIRED V NON-OWNED I (Per DAMAGE S /� AUTOS ONLY Ff AUTOS ONLY ) . S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE__ _ S ' DED I I RETENTIONS S WORKERS COMPENSATION X ;MUTE OTH- ER AND EMPLOYERS'LIABILITY --_.. A OFFCEWMEMBEREXCLUD XECUTIYE I] NIA WRK0038421 01/01/2017 0/01/2018 E.L.EACH ACCIDENT s 1D0.000 -- (Mandatory In NH) E.L.DISEASE-EA EMPLOYEES 500.000 II yes. IPTION under DESCRIPTION OF OPERATIONS bebw E.L.DISEASE-POLICY LIMIT S 100�. • DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 10i,Additional Remarks Schedule,may be attached if more space la required) THE CITY OF OSHKOSH AND ITS EMPLOYEES AND OFFICERS LISTED AS ADDITIONAL INSURED ON COMMERCIAL GENERAL LIABILITY. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN THE CITY OF OSHKOSH ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 1130 AUTHORIZED REPRESEN 215 CHURCH AVE a...4,---e...-."._,I,fre_e_e_,,f____, OSHKOSH WI 54903 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD