HomeMy WebLinkAboutUnited Concrete & Construction 7-1-18 AC L P DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 07/06/2017
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: CLIENT CONTACT CENTER
FEDERATED MUTUAL INSURANCE COMPANY PHONE
HOME OFFICE: P.O. BOX 328 (A/CC,No,Ext):888-333-4949 FAX
No):507-446-4664
OWATONNA, MN 55060 AIL
ADDRESS:CLIENTCONTACTCENTER(aFEDINS.COM
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED 391-359-7 INSURER B:
UNITED CONCRETE &CONSTRUCTION INC INSURER C:
5902 N RICHMOND ST
APPLETON,WI 54913-9642 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 12 REVISION NUMBER:0
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 NUMBER POLICY EFF POLICY EXP LIMITS
LTRINSR WVD (MM/DD/YYYY) (MMIDD/YYYY)
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000
DAMAGE TO RETED
CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $100,000
MED EXP(My one person) EXCLUDED
A Y N 6048574 07/01/2017 07/01/2018 PERSONAL d ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
X POLICY PRO JECT LOC PRODUCTS-COMP/OP AGO $2,000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
(Ea accident
X ANY AUTO BODILY INJURY(Per person)
OWNED AUTOS ONLY SCHEDULED
AUTOS_ACHEOS N N 6048574 07/01/2017 07/01/2018 BODILY INJURY(Per accident)
HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE
AUTOS ONLY (Per accident
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $1,000,000
A EXCESS LIAR CLAIMS-MADE N N 6048577 07/01/2017 07/01/2018 AGGREGATE $1,000,000
DED RETENTION
WORKERS COMPENSATION OTH•
X PER STATUTE ER
AND EMPLOYERS'LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $500,000
A OFFICERIMEMBER EXCLUDED? N/A N 6048575 07/01/2017 07/01/2018
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000
If yes,describe under E.L DISEASE-POLICY LIMIT
DESCRIPTION OF OPERATIONS below $500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
POLICY COVERAGE AS OF 07/05/2017
THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES
OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY.
CERTIFICATE HOLDER CANCELLATION
391CITY
7 - G�>t� 12 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITY OF H,WI54 OSHKOSH -CITY CLERK °° It 1
PO BOX 1130 {{ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN
OSHKOSH,WI 54903-1130 1UL 1$ 1�17 ACCORDANCE WITH THE POUCY PROVISIONS.
p1rFCE AUTHORIZED REPRESENTATIVE g226„,--
•
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