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HomeMy WebLinkAboutWally Schmid Excavating Inc 4-14-18 ____.--.40 SCHMI02 OP ID:JV ACORO DATE(MM/DD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 06/28/2017 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 ADEMINO&ASSOCIATES INC NAME: DAVID VAN BOOGARD DAVID ADEMINO (AHO"N,e<t):920-734-3110 FAX NO): 920-734-6027 1001 TRUMAN P 0 BOX 99 ADDRE KIMBERLY,WI 54136-0099 SS:dvanboogard@ademino.com DAVID VAN BOOGARD INSURER(S)AFFORDING COVERAGE NAIC IS INSURER A:SELECTIVE INSURANCE 19259 INSURED WALLY SCHMID EXCAVATING INC INSURERS: 7821 SWISS RD OSHKOSH,WI 54902 INSURER C: INSURER D: 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 EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MMIDDIYYYY) (MM!DD/YYYY) A X COMMERCIAL GENERAL LIABILITY 1 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X S 2270770 04/14/2017 04/14/2018 DAMAGE TO RENTED PREMISES(Ea occurrence) $ 500 000 MED EXP(Any one person) $ 15,000 PERSONAL&ADVINJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 3,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO S 2270770 04/14/2017 04/14/2018 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS - - NON OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 2,000,000 A EXCESS LIAB CLAIMS-MADE S 2270770 11/16/2017 04/14/2018 AGGREGATE 5 2,000,000 DED X RETENTIONS 0 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N A ANY PROPRIETOR/PARTNER/EXECUTIVE N/A WC 9052201 04/14/2017 04/14/2018 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 I ` DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if mom space is required) ' 1 E . ,...`,2• - CITY OF OSHKOSH&ITS OFFICERS COUNCIL MEMBERS AGENTS EMPLOYEES& AUTHORIZED VOLUNTEERS ARE ADDITIONAL INSURED WHERE REQUIRED BY WRITTEN U IUN 2 Q 2017 CONTRACT SUBJECT TO POLICY TERMS AND CONDITIONS. .J CITY CLERK'S OFFICE. CERTIFICATE HOLDER CANCELLATION OSCIT-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF OSHKOSH THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 215 CHURCH ST OSHKOSH,WI 54901 AUTHORIZED REPRESENTATIVE a1/40ml1• - ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD