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HomeMy WebLinkAboutMichael & Jenelle Spaeth 10-9-18 AC�® DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 08/15/2018 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 Derek Elwood NAME: State Farm The Elwood Agency (A/C.PHONE 920-235-2456 {wc,_n1oJ: 920-235-4848 O 515 S Washburn St Suite 105 E-MAIL www.elwoodsagency.com O'O. ADDRESS: Oshkosh,WI 54904 INSURER(S)AFFORDING COVERAGE NAIL INSURER A: INSURED INSURER B: Michael and Jenelle Spaeth INSURER C: 1508 Northpoint St INSURER D: Oshkosh,WI 54901 INSURERE: 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 ADOL SUER POLICY EFF POUCY EXP LTR TYPE OF INSURANCE INSD WVD POUCY NUMBER IMWDONYYYI (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO CLAIMS-MADE I j D OCCUR PREM SES(Ea occurrence)REN $ MED EXP(Any one person) f PERSONAL&ADV INJURY f GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE f POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG f OTHER: AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $ (Ea accident) ._ ANY AUTO BODILY INJURY(Per person) f OWNED r I SCHEDULED BODILY INJURY(Par accident) f _ H ONLY I____.'AUTOS HIREDIRED I NON-OWNED PROPERTY DAMAGE f AUTOS ONLY I AUTOS ONLY (Peraccide f UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LAB ^CLAIMS-MADE AGGREGATE f DED RETENTION f f WORKERS COMPENSATION PER - AND EMPLOYERS'UABWTY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT f 'OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$_ If yes,descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT f Personal Liability 500,000.00 Homeowner X 49-82-T512-5 10/09/2015 10/09/2018 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of OshkOSk ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Ave AUTHORIZED REPRESENTATIVE PO Box 1130 Oshkosh,WI 54903 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132849.12 03-16-2016