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HomeMy WebLinkAboutWood Sewer & Excavating Inc 6-1-18 A CERTIFICATE OF LIABILITY INSURANCE 5/25/20��Dnvvv) 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). CONTPRODUCER NAMEACT Bri Hauge Ansay&Associates, LLC. GB (PHONE /°N.Exu:800-236-8652 Fac,Not:920-437-4179 419 South Washington Street ADOAaless:Bri.Hau eCcr�ansa com PO Box 22368 9 y• Green Bay WI 54305 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Insurance Company 10677 INSURED WOODSEW-01 INSURER B: Wood Sewer& Excavating Inc INSURERC: E9238 Cty X INSURER D: New London WI 54961-7820 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:314509824 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 NOTVNTHSTANDING 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS A GENERAL LIABILITY Y EPP 0018996 6/1/2017 6/1/2018 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $500,000 - CLAIMS-MADE X OCCUR MED EXP(Any one person) $10,000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000,000 POLICY X 721 X LOC $ A AUTOMOBILE LIABILITY Y EBA 0018996 6/1/2017 6/1/2018 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) A X UMBRELLA LIAB X OCCUR EPP 0018996 6/1/2017 6/1/2018 EACH OCCURRENCE _$5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$0 $ A WORKERS COMPENSATION EWC 0319321 6/1/2017 6/1/2018 X N/C STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY I IMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatcry in NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 A Installation Floater EPP 0018996 6/1/2017 6/1/2018 Any One Job Site $250,000 Deductible $500 DESCRIPTION OF OPERATIONS/LOCATIONS/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 included as additional insured with respects to general liability coverage by endorsement GA233 02/07(ongoing operations) &CG2037 (completed operations)on a primary& non-contributory basis per form GA4094 and auto liability per endorsement AA4004 on a primary& non-contributory basis per form AA4174. 30 days Notice of cancellation except 10 days for non-payment of premium in favor of additional insured. CERTIFICATE HOLDER CANCELLATION ��++ City of Oshkosh RECEIVED ii`, T l C�L THE EXPIRATION ANY OF DATEE DATTEOVE DESCRIBED THE THEREOF, NOTICE POLICIES WILLL CBE CELLED DELIVERED BEFORE IN Attn: City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Avenue MAY 3 0 201 i PO Box 1130 Oshkosh WI 54903-1130 — AUTHORIZED REPRESENTATIVE CITY CLERK'S OFFICE -1/J , I �� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD