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HomeMy WebLinkAboutTom Van Handel Corp 2-1-18 ACORCI CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1/23/2017 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 CONTNAME: Tiffanie Courtney M3 Insurance Solutions, Inc. PHONE 920-405-9162 FAX 480 Pilgrim Way, Suite 1230 EMAIL Est) (AIC.No): Green Bay WI 54304 E-MAILADDREss,tiffanie.courtney@m3ins.com INSURER(S)AFFORDING COVERAGE NAIC tr INSURER A:Acuity Insurance Company 14184 INSURED VAN HT-1 INSURER B: Tom Van Handel Corp. INSURER C: 1830 E. Edgewood Drive Appleton WI 54913 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 2134020223 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 ADDCSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD!WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) UMITS A X COMMERCIAL GENERAL LIABIUTY Y Y Z12983 2/1/2017 2/1/2018 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED l CLAIMS-MADE l X J OCCUR PREMISES(Ea occurrence) $250,000 MED EXP(Any one person) $10,000 PERSONAL 8 ADV INJURY $1,000,000 _GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY X JE a X LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y 212983 2/1/2017 2/1/2018 COMBINtD SINGLE LIMIT E (Ea accident) 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HI OS ONLY NON-OWNED ONL PROPERTY DAMAGE $ AUTOS (Per accident) $ A UMBRELLA LIAB X OCCUR Y Y Z12983 2/1/2017 2/1/2018 EACH OCCURRENCE $5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTIONSO • S A WORKERS COMPENSATION Z12983 2/1/2017 2/1/2018 X PER ERH- AND EMPLOYERS'LIABILITY STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Oshkosh, its Officers, Council Members,Agents, Employees, and Authorized Volunteers are includedRjiMrlrareds ith respects to General Liability where required by written contract.30 day Notice of Cancellation, to the Certificate Holder, is included on the policy. JUN 3 0 2017 CiltV CLEWS°MICE 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 City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Street Oshkosh WI 54901-4747 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD