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HomeMy WebLinkAboutZillges Materials Inc 7-1-18 F Al Ir - ACO® DATE IMMfDD1YYYY(ii CERTIFICATE OF LIABILITY INSURANCE kri....------- 7/13/2(117 , THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISr5' 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 t the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to thee; certificate holder in lieu of such endorsement(s). ONT PRODUCER NAMEACT Ann Wehrle Ansay &Associates, LLC. FV PHONE 920-560-7000 FAX 920 560-7078 4351 W College Ave E MAIb`in Fail- A1C-NQJ I Suite 310 ADDRESS ann.wehrle@ansay.com Appleton,WI 54914 INSURER(S)AFFORDING COVERAGE NAIC if INSURER A:West Bend Mutual Insurance Company 15350 ¢;' INSURED . ZILLMAT-03 INSURER B: , .4. Ziilges Materials, Inc. INSURER C: -- • 1990 W Snell Road INSURER D: Oshkosh WI 54904 i INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1371076607 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' 'AtJUCSUBR--- POLICY EFF POLICY EXP LIMITS LIR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYVY) (M M(DOlYYVY) A x COMMERCIAL GENERAL LIABILITY Y Y 0708525 7/1/2017 7/1/2018 EACH OCCURRENCE S1,000,000 • ITAMAUTU-Rt=N 1 EU LJCLAIMS-MADE 1X I OCCUR PREMISES(Ea occurrence) $200,000 _-_� . MED EXP(Any one person) $10,000 -.1.� PERSONAL 8 ADV INJURY 11,000,000 G—E_'L AGGREGATE UMIT APPLIES PER GENERAL AGGREGATE S2,000,000 ;`1 X 'POLICY I J JECOT LJ LOC PRODUCTS-COMP/OPAGG f2,000,000 — 1 .. OTHER S A AUTOMOBILE LIABILI IV 070t 325 7/1/2017 7/1/2018 a acudengS)NGLL LIMO f 1,000,000 X ANY AUTO BODILY INJURY(Per person) f . ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOSI NON--OWNED -T'ROI'ERTY DAMAGE S ---- HIRED AUTOS AUTOS Per accident) -- — S A X UMBRELLA LIAO X OCCUR 0708525 7/1/2017 7/1/2018 EACH OCCURRENCE 35,000,000 , EXCESS LIAO CLAIMS-MADE AGGREGATE $5,000,000 I _ _ DED I RETENTION S S y A WORKERS COMPENSATION y 0708526 7/1/2017 7/1/2018 T4TATI�E X H•ER i AND EMPLOYERS'LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE I E.L.EACH ACCIDENT S500,000 i OFFICER/MEMBER EXCLUDED? N NIA — .j (Mandatory In NH) E L DISEASE-EA EMPLOYEE S500,000 _ I IDf kEes CROeN uOF eO'ERAfIONS beaw E L DISEASE-POLICY LIMIT $500,000 A 1Inland Marine 07013525 7/1/2017 7/1/2018 Rented Equipment 100,000 1 j DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) 1 City of Oshkosh and its officers, council members, agents,employees and authorized volunteers,are additional insured. c RECEIVED 1`8 1 CERTIFICATE HOLDER CANCELLATION ' ,i AUG 292017 ( >.1 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOREI •`-, City of Oshkosh L-------;— l THE EXPIRATION DATE I THEREOF, NOTICE WILL BE DELIVERED lc :ii 215 Church Ave CITY CLERKS OFFICE,, ACCORDANCE WITH THE POLICY PROVISIONS. )f Oshkosh WI 54901 — -------- '} usa AUTHORIZED REPRESENTATIVE L i ©1988-2014:AC0RD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD il- i' 1� .1 i'' 1