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HomeMy WebLinkAboutWisconsin Bell Inc 6-1-18 ' 1 A� RODATE(MM1DDlYYYY) ®O CERTIFICATE OF LIABILITY INSURANCE 0 8/2 112 0 17 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 Marsh USA Inc. NAME: 701 Market Street,Suite 1100 (A/C.o.Extt: AIC,No) St.Louis,MO 63101 E-MAIL Attn:ATT.CertRequesl@marsh.com ADDRESS. INSURER(S)AFFORDING COVERAGE NAIC S 018566-GAW-CRT-17-18 X INSURER A:Old Republic Insurance Company 24147 INSURED - INSURER B Wisconsin Bell,Inc. 2 One AT&T Plaza , INSURER C: 208 South Akard,Room 1830.06 1 INSURER D: Dallas,TX 75202 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: CHI-007306081-08 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 SUER POLICY EFF POLICY EXP LIMITS LTR MDW IY VD POLICY NUMBER IMM/DD/YYYY) IMM/DDYYYI A X COMMERCIAL GENERAL LIABILITY MWZY 310368 06/01/2017 06/01/2018 EACH OCCURRENCE S 1,000,000 --WAGE TO J CLAIMS-MADE LXJ OCCUR PREMISES(EaENTED occurrence) $ 1•000'000 MED EXP(Any one person) S N/A PERSONAL 8 ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000'000 X POLICY PRO LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ MWTB 310367 06/01/2017 06/01/2018 COMBINED SINGLE LIMIT s 1,000,000 A AUTOMOBILE LIABILITY (Ea accident) A X ANY AUTO MWZX 310369(MI) (See Attached) 06/01/2017 06/01/2018 BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION MWC31037000 06/01/2017 06/01/2018 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N 1,000,000ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 A Excess Workers'Compensation/ MWXS 310371 (OH-WA) 06/01/2017 06/01/2018 EL Each Accident/EL Disease 1,000,000 Employers'Liability See Second Page EL DiseasPrIi'y limit f+000,000 RECEIVED DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) r ( { AUG 21 2017 1 CITY CLERK'S OFFICE CERTIFICATE HOLDER CANCELLATION City of Oshkosh SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn:Matthew Nett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 Church Ave. ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1130 Oshkosh,WI 54903-1130 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee auDo►,► ►v,cf-ct ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD