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HomeMy WebLinkAboutSommers Construction Co Inc 1-1-18V SOMMERS-02 KIJU A`aR CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/23/2016 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 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 (262)542-8822 NAME:CT Julie Kinjerski WSC/Associated Financial Group PHONE FAX P.O.Box 1630 (A/C,No,EXt):920.731.0400 (A/c,No):920.731.4072 E-MAIL •ulie.kin erski^associatedbrc.com Waukesha,W153187-163D ADDRESS:I ) `' INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:Charter Oak Fire Insurance Co. INSURED Sommers Construction Co Inc INSURER B:Travelers Indemnity Company of America W7841 Smith St INSURER C:Travelers Indemnity Company Shiocton,WI 54170-8599 INSURER 0:Travelers Indemnity Co.of Connecticut INSURER E: 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 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 LIMBS LTR INSR WVD POLICY NUMBER (MM/DDIYYYY) (MMIDD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X DT-CO-4F186546-PHX 01/01/2017 01/01/2018 DAMAGE TO RENTED 300,000 PREMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER- PRODUCTS-COMP/OP AGG S 2,000,000 POLICY X PJECT RO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ B X ANY AUTO X DT-810-4F186546-TIA 01/01/2017 01/01/2018 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (PER ACCIDENT) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS-MADE DTSM-CUP-4F186546-IND 01/01/2017 01/01/2018 AGGREGATE $ 5,000,000 DED X RETENTIONS 10,000 $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER D ANY PROPRIETOR/PARTNER/EXECUTIVE YlN DTDTBEUB-4F18654-6 01/01/2017 01/01/2018 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N N I A - - - - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,descnbe under DESCRIP T ION Or OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 I � DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) City of Oshkosh,and its officers,council members,agents,employees and authorized volunteers 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 215 Church Street ACCORDANCE WITH THE POLICY PROVISIONS. Oshkosh,WI 54903- AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD