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HomeMy WebLinkAboutVan Ert Electric Co 1-1-18 AWRL7 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/12/2017 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 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: IM3 Insurance Solutions, Inc. PHONE FAX 3406 Oakwood Hills Parkway, Suite 400 Om.No.Ext):715 830-1840 _ (A/C,No): IL Eau Claire WI 54701 ADDRESS: PRODUCER CUSTOMER ID 8:VANER-1 INSURER(S)AFFORDING COVERAGE NAIC 8 INSURED INSURER A:COlumbia Casualty 31127 Van Ert Electric Co. Inc. INSURERB:The Travelers Indemnity Co. 36137 Stewart Stewart Avenue Wausau WI 54401 INSURERC:The Travelers Indemnity Co. 36137 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1619153151 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) B GENERAL LIABILITY DTCO3F827504PHX17 1/1/2017 1/1/2018 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED 000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $300, _ CLAIMS-MADE X OCCUR MED EXP(Any one person) $10,000 PERSONAL 8 ADV INJURY $1,000,000 GENERALAGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PRO- JECT B AUTOMOBILE LIABILITY DT8103F827504C0F17 1/1/2017 1/1/2018 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ $ B X UMBRELLA LIAB X OCCUR DTSMCUP3F827504TIL17 1/1/2017 1/1/2018 EACH OCCURRENCE $10,000,000 EXCESSLIAB CLAIMS-MADE AGGREGATE $10,000,000 DEDUCTIBLE $ _ X RETENTION $10,000 $ B WORKERS COMPENSATION DTDF5UB3F82750417 1/1/2017 1/1/2018 X TATU- OTH- AND EMPLOYERS'LIABILITY Y/N TWCSORY LIb11TS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 I OFFICER/MEMBER EXCLUDED? N N/A -(Mandatory In NH) - E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes.describe under I DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 B ILeased\Rented Equipment QT6601D653746C0F17 1/1/2017 1/1/2018 Per Item 200,000 A Professional Liability 6016836656 1/1/2017 1/1/2018 Occur\Agg 2,000,000 C Installation Floater QT6601D653746C0F17 1/1/2017 1/1/2018 Limit 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) City of Oshkosh, and its officers, council members, agents, employees and authorized volunteers are additional insureds with regard to General Liability. 30 day notice of cancellation provided CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED CITY OF OSHKOSH IN ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 1130 OSHKOSH WI 54903-1130 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD