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HomeMy WebLinkAboutSuperior Sewer and Water Inc 4-17-18 DATE(MM/DD/YYYY) A o® CERTIFICATE OF LIABILITY INSURANCE 1/29/2018 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 poilcy(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 CONTACT Nadine Sanders E:NAM Alliance Insurance Centers LLC Pr Ne EXtI: (920)330-9000 Irv.No): (920)330-9001 3138 Market Street E-MAIL ADDRESS:nsanders@allianceinsurancecenters.nom INSURER(S)AFFORDING COVERAGE NAIC Green Bay WI 54304 INSURER AMeet Bend Mutual Insurance 15350 INSURED INSURER B: _ — Superior Sewer and Water Inc. INSURERC: 4309 County Rd P INSURERD: INSURER E: New Franken WI 54229 INSURERF: COVERAGES CERTIFICATE NUMBER:17/18 CERT 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 I TYPE OF INSURANCE AbDLISUBR` - - - POLICY EFF POLICY EXP UMITS LTR I INSR II WVD POLICY NUMBER IMM/DO/YYYYI IMM/DD/YYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAGE TO RENTED A J CLAIMS-MADE I Xi OCCUR I PREMISES SES ER occurrence) $ 200,000 X A275158 4/17/2017 4/17/2018 MED EXP(Any arieperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X 1 POLICY( X J JE LOC PRODUCTS-COMP/OP AGG $ 2,000,000 I 11 OTHER: $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ 1,000,000 (Ea accidenj)_ —_-- -- A X ANY AUTO BODILY INJURY(Per person) $ ALLOWNED r l SCHEDULED A275158 4/17/2017 4/17/2018 BODILY INJURY(Per accident) $ AUTOS IAUTOS I NO OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) _ _ _ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE_ $ 1,000,000 A EXCESS LIAABB CLAIMS-MADE AGGREGATE J $ 1,000,000 DED i X !RETENTIONS 0 A275158 4/17/2017 4/17/2018 $ WORKERS COMPENSATION ' PER OTH- AND EMPLOYERS'LIABILITY YIN X I STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N 1 A - ---- A (Mandatory In NH) A275164 4/17/2017 4/17/2018 E.L.DISEASE-EA EMPLOYEE`$ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A I Inland Marine A275158 4/17/2017 4/17/2018 Rented&Leased Equipment $175,000 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) _ -_� - _ City of Oshkosh, its employees and officers are listed as an Additional Insure. . nett_ PEf 8 0 6 2018 CITY CLERICS C��'�Y'CE 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 Ave ACCORDANCE WITH THE POLICY PROVISIONS. Oshkosh, WI 54903 AUTHORIZED REPRESENTATIVE Jeff Mathu/NS ,C;:::.h z„ 'e' ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I N S025(201401)