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HomeMy WebLinkAboutComplete Flatwork Specialists LLC 03-30-20 �...,N COMPL-1 OP ID:JR ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDlYYYY) 416 ...----- 07/08/2019 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 920-734-3110 ! CONTACT NAME: JYL A RANDERSON ADEMINO 8 ASSOCIATES • PHONE,Ext):920-734-3110 1 FAX No):920-734-6027 1001 TRUMAN P 0 BOX 99 KIMBERLY,WI 54136-0099 RECEIVED ioo IR`ssjranderson@ademino.com JYL A RANDERSON INSURER(S)AFFORDING COVERAGE NAIC 0 1 201g INSURER A:SHEBOYGAN FALLS INS COMPANY 15148 INSURED COMPLETE FLATWORK SPECIALISTS JUL + O _INSURER B: LLC W1944 INDUSTRIAL DR guRERC: KAUKAUNA,WI 54130 - DEPT OF PUBLIC WOL uRERD: OSHKOSH, W1SCON5) NSURER 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' IADDL SUBRI I POLICY EFF I POLICY EXP LTR TYPE OF INSURANCE I INSO WV. POLICY NUMBER (MMIDD/YYYYI IMM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CPP2004686 03/3012019 03/30/2020 DAMAGE TO RENTED 100,000 Y PREMISES(Ea occurrence) .$ _____ 5,000 MED EXP(Any one person) $ _ PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE pL�IMpITAPPUESPER: GENERAL AGGREGATE $ 3'000'000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG ,$ 3,000,000 I OTHER: S A AUTOMOBILE LIABILITY *CO aBI�NdEDISINGLE LIMIT 1,000,000 X ANY AUTO CA2004686 03/30/2019 03/30/2020 BODILY INJURY(Per person) $ - OWNED .- SCHEDULED _ AUTOS ONLY _ AUTOSN BODILY INJURY(Per accident) $ _ AUTOS ONLY _ AUTOSO ONE (PeOr PER tDAMAGE $ S A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE CXY2004686 03/30/2019 03/30/2020 AGGREGATE $ 1,000,000 DED I X I RETENTION$ 0 $ A AND EMPLOYERS'LIABILITY X STATUTE I I NH- ANY PROPRIETOR/PARTNER/EXECUTIVEY!N WCY2004686 03/30/2019 03/30/2020 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EAEMPLOEE_$_ 100,000 It yes,descnbe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule.may be attached it more space is required) CITY OF OSHKOSH, ITS OFFICERS,COUNCIL MEMERS,AGENTS,EMPLOYEES AND AUTHORIZED VOLUNTEERS ARE ADDITIONAL INSUREDS WHERE REQUIRED BY WRITTEN CONTRACT SUBJECT TO POLICY TERMS AND CONDITIONS. CERTIFICATE,HOLDER CANCELLATION OSCIT-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF OSHKOSH OF WINNEBAGO ACCORDANCE WITH THE POLICY PROVISIONS. CTY 215 CHURCH ST AUTHORIZED REPRESENTATIVE PO BOX 1130 JYL A RANDERSON OSHKOSH,WI 54901 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD