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HomeMy WebLinkAboutSigma Group 10-1-18 1,1111°. ACLR D CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDYYYY) 10/11/2017 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 1-414-443-0000 CONTACT NAME: Hays Companies of Wisconsin, Inc. PHONE FAX (A/C No.Ext): _ (A/C,No): E-MAIL 1200 North Mayfair Road, Suite 100 ADDRESS: INSURERS)AFFORDING COVERAGE NAIC# Milwaukee, WI 53226 INSURERA: NAUTILUS INS CO 17370 INSURED INSURER B: VALLEY FORGE INS CO 20508 The Sigma Group, Inc. INSURER C: TRANSPORTATION INS CO 20494 1300 West Canal Street INSURERD: INSURER E: Milwaukee, WI 53233 INSURERF: COVERAGES CERTIFICATE NUMBER: 51115463 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. ISR LTR NSD WVD, POLICY NUMBER BR POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE (POLICY YEFF (POLICY Y Y)P A X COMMERCIALGENERALLIABILITY X ECP2024210-10 10/01/17 10/01/18 EACHOCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR DAMAGO E 300,000 _ ( PREMISES{Ea occurrence) $ MED EXP(Any one person) $ 25,000 PERSONAL BADVINJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 _ POLICY X PRO-JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: _ $ B AUTOMOBILE LIABILITY X 6042795128 08/01/17 08/01/18 (Ea COMaccideBINEeUINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ A UMBRELLA LIAB X OCCUR FFX2024211-10 10/01/17 10/01/18 EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTION$ 0 $ C WORKERS COMPENSATION 6042795145 08/01/17 08/01/18 SUTE ERH X TAT AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETORJPARTNER/EXECUTIVE N NIA E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Pollution - Occur. ECP2024210-10 10/01/17 10/01/18 Limit 2,000,000 A Professional-C.M. ECP2024210-10 10/01/17 10/01/18 Occ./Agg. Limit 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Professional Liability Retroactive Date 8/01/87. Excess policy also applies to Pollution and Professional. The City of Oshkosh and its officers, council members, agents, employees and authorized volunteers are included as additional insured on the general and automobile liability policies when required by written contract. A 30 day notice of cancellation, except 10 days for non-payment will be provided to those parties indicated in the written contract. 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 ACCORDANCE WITH THE POLICY PROVISIONS. Attn: City Clerk P.O. Box 1130 AUTHORIZED REPRESENTATIVE Oshkosh, WI 54903 0-A0 USA ?J ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD diannewandel 51115463