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HomeMy WebLinkAboutTDS Metrocom LLC 1-1-18 ® DATE(MM/DD/YYYY) A�-� CERTIFICATE OF LIABILITY INSURANCE 12/29/2016 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 CONTACT MARSH USA INC. NAME` PHONE FAX 540 W.MADISON (A/C.No,Exti: (A/C,No): CHICAGO,IL 60661 E-MAIL Attn:Chicago.CertRequest@marsh.com I Fax:212-948-0770 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC N CT EXP 123113 PROP INSURER A:Sentry Casualty Company 28460 INSURED INSURER B:Sentry Insurance A Mutual Company 24988 TELEPHONE AND DATA SYSTEMS,INC. TDS METROCOM,LLC INSURER C:N/A N/A 30 N.LASALLE STREET INSURER D SUITE 4000 CHICAGO,IL 60602 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: CHI-006212487-41 REVISION NUMBER:15 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 INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDD/YYYY) B X COMMERCIAL GENERAL LIABILITY 90-02578-11 01/01/2017 01/01/2018 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED I CLAIMS-MADE IX 1 OCCUR PREMISES(Ea occurrence) $ 2,000,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 4,000,000 X POLICY JE T LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER. $ B AUTOMOBILE LIABILITY 90-02578-04 01/01/2017 01/01/2018 COMBINED SINGLE LIMIT $ 5000000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE HIRED AUTOS AUTOSO NON-OWNED $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB _ CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 90-02578-01(DED)(AOS) 01/01/2017 01/01/2018 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 90-02578-02 01/01/2017 01/01/2018 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A(Mandatory In NH) (WI,MA,NY,ND,OH,WA) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re:Annual License,Citywide City of Oshkosh,and its officers,council members,agents,employees and authorized volunteers is/are included as additional insured as respects operations performed by or on behalf of the named insured as required by written contract. This insurance is Primary and Non-Contributory over any existing insurance and limited to liability arising out of the operations of the Named Insured and where required by written contract. CERTIFICATE HOLDER CANCELLATION City of Oshkosh SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 215ChurchAvenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Oshkosh,WI 54901 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee _1VCAuan�: .S4atc.w�u ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD