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HomeMy WebLinkAboutWaas Boring and Cable Inc 7-1-18 WAASBOROPC PDEANOVICH ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1210112017 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 mom. NRM PRODUCER ACT Pamela Deanovich,CISR Jackson Kahl Insurance Services,LLC 17 N Pioneer Road jAH/c°°,Ne,Ext):(920)923-40201112 FAX Ne):(866)218-6850 Fond Du Lac,WI 54935 dst' ss:pdeanovich@jacksonkahl.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:West Bend Mutual Insurance Co. 15350 INSURED INSURER B Waas Boring and Cable,Inc. INSURERC: N10483 Waas Road INSURERD: Lomira,WI 53048 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 WVD IMM/DD/YYYY) IMMIDD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE E 1,000,000 CLAIMS-MADE X OCCUR X 0762896 07/01/2017 07/01/2018 PREMISESt irNcTTErrence) $ 200,000 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 JEI T LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: S A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) S X ANY AUTO 0762896 07/01/2017 07/01/2018 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSOE ONLY AUTOS W� BODILY INJURY(Per accident) $ X AUTO ONLY X AUUTOS ONL YY (Perr accdent)AMAGE $ A X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 9,000,000 EXCESS!JAB CLAIMS-MADE 0762896 07/01/2017 07/01/2018 AGGREGATE S 9,000,000 DED X RETENTION$ 0 $ A WORKERS COMPENSATION X STATUTE ERH Y/N 0762897 07/01/2017 07/01/2018 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 5 OFFICERMIEM UgEER EXCLUDED? N N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 It yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Oshkosh,its employees and officers are Additional Insured per WB1482 0113 form,when required by written contract,on the General Liability as respects operations performed by the Named Insured. 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 Street Oshkosh,WI 54903-1128 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD