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HomeMy WebLinkAboutVan Straten Construction Co 9-1-18 VANSTRA-01 JSCHULTZ coszo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/29/2017 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 NQfTACT Jill R.Schultz,AU,PWCAM Johnson Insurance Northeast PHONry, ):(920)445-7401 I FAX g77 254-8586 318 South Washington Street (A/C,No):( ) Green Bay,WI 54301 2IDAFIEss:Jschultz@johnsonins.com INSURER(S)AFFORDING COVERAGE NAIC at INSURER A:Secura Insurance 22543 INSURED INSURER B: Van Straten Construction Co Van Straten Materials LLC INSURER C: 2117 S Oneida St INSURER D Green Bay,WI 54304 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD N/VD IMM/DD/YYYY) IMM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 MAGERENTED CLAIMS-MADE X OCCUR CP3196649 09/01/2017 09/01/2018 pREM SESO(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY X !Ea LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: S A COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY (Ea accident) $ X ANY AUTO A3196650 09/01/2017 09/01/2018 BODILY INJURY(Per person) $ _ OWNED SCHEDULED AUTOS ONLY _ AUTOS SSyy p BODILY INJURY(Per accident) $ HIREDTS ONLY AUTOS ONLY (Per PROPERTY tDAMAGE $ E A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 3,000,000 EXCESS LIAB CLAIMS-MADE CU3196652 09/01/2017 09/01/2018 AGGREGATE S 3,000,000 DED X RETENTIONS 10,000 S A WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE OTH- ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WC3196651 09/01/2017 09/01/2018 E.L.EACH ACCIDENT $ N/A 100,000 OFFICER/MEMBER EXCLUDED? 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes.describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RECEIVED City of Oshkosh,its officers,council members,agents employees& authorized volunteers are included as Additional Insured with respect to General Liability AUG 2 9 2017 CITY CLERK'S OFF (: CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Ave Oshkosh,WI 54901 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD