Loading...
HomeMy WebLinkAboutStatewide Razing Inc & Martin Recycling 11-7-18 ACORL® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) illiumw.- 11/14/2017 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: Connie Campbell PHBay Insurance Agency,Inc. (NC.No. ,t): (920)339-8262 FAX No): (920)339-8294 _ 3136 Holmgren Way, P.O. Box 28077 E-MAIL ccampbell@bayinsagency.com _ Green Bay,WI 54324-0077 INSURER(S)AFFORDING COVERAGE NAIC a INSURER A: United National Insurance Company/Speciality Line INSURED INSURER B: Society Insurance Statewide Razing Inc. &Martin Recycling, Inc. INSURERC: Merchants National Inc.Co 103 Vosters Vista INSURER D: Amerisafe Combined Locks,WI 54113 INSURERE: Everest Indemnity Ins _ INSURER F: COVERAGES CERTIFICATE NUMBER: 00000000-4684107 REVISION NUMBER: 57 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 SUBR POLICY EFF POLICY EXP LIMITS LTR WSD WVD POLICY NUMBER IMMIDD/YYYYI (MM/DDPYYYY) A X COMMERCIAL GENERAL LIABILITY Y L7219828 11/22/2017 11/22/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ X XCU hazard - includ MED EXP(Any one person) $ 5,000 X contractual liabili PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE $ 2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ g AUTOMOBILE LIABILITY Y CAP517464 11/07/2017 11/07/2018 COMBINaccidEDen SINGLE LIMIT $ {Ea t) 1,000,000 ANY AUTO BODILY INJURY(Per person) $ — OWNED r,— SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS HIRED NON- D PROPERTY DAMAGE $ X AUTOS ONLY X AUTOSOWNE ONLY (Per accident) X Owned Private F'j(ssOwned Autos O/T Pri $ C` X UMBRELLA LIAB X OCCUR Y EXL0000142 11/22/2017 11/22/2018 EACH OCCURRENCE $ 3,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000,000 DED ' X RETENTION$ 0 $ D AND EMPLOYOERS'NABILOI TY W AVCWI2581672017 03/26/2017103126/2018 X STATUTE EERH ANY PROPRIETOR/PARTNER/EXECUTIVE YIN • E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 E Environmental EF4P001915-121 11/22/2017 11/22/2018 1000000 1,000,000 i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RECEIVED City of Oshkosh is listed as Additional Insured,with a 30 day notice of cancellation. — NOV 162017 CITY CLERK'S OFFICE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Oshkosh, Attn: City Clerk THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 215 Church Avenue ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1130 Oshkosh, WI 54903-1130 AUTHORIZED REPR TATIVE / — ©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 November 14,2017 at 01:13PM