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HomeMy WebLinkAboutSignma Group 10-1-19 ACO GO DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/28/2018 k......----- 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 1-414-443-0000 CONTACT NAME: Hays Companies PHONE FAX 'R.ECEIYED 7 T (A/C,No.Est): E-MAIL (AIIJ No): 1200 North Mayfair Road, Suite 100 ADDRESS: _ I NSURER(S)AFFORDING COVERAGE _ NAIC# Milwaukee, WI 53226 SEP 10 201q INSURERA: Tokio Marine Specialty Inc. Co. INSURED INSURERS: VALLHY FORGE INS CO 20508 The Sigma Group, Inc. DLPT OF PUBLIC WORKS INSURERC: TRANSPORTATION INS CO 20494 1300 West Canal Street OSHKOSH, WISCONSIN INSURERD: INSURER E: Milwaukee, WI 53233 INSURERF: COVERAGES CERTIFICATE NUMBER: 54191150 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. MSR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER (MM/DDPOLICY LT /YYYY1 (MM DDIYYYYI LIMITS LTR INSO WVD A X COMMERCIALGENERALLIABILITY X PPK1887402 10/01/18 10/01/19 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED CLAIMS-MADE I X I OCCUR PREMISES Ea occurrence) $ 300,000 MED EXP(Any one person) $ 25,000 PERSONAL BADVINJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECOT- LOC PRODUCTS-COMP/OPAGG $ 2,000,000 $ OTHER: COMBINED SINGLE LIMIT B AUTOMOBILE LIABILITY X 6042795128 08/01/18 10/01/19 (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED (Per accident) TY DAMAGE $ AUTOS ONLY AUTOS ONLY A UMBRELLALIAB X OCCUR PUB649141 10/01/18 10/01/19 EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTION$ 0 $ C WORKERS COMPENSATION 6042795145 10/01/18 10/01/19 X STATUTE ERH AND EMPLOYERS'LIABILITY ANYPROPRIETORJPARTNER/EXECUTIVE NN NIA E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Professional-C.M. PPK1887402 10/01/18 10/01/19 Occ./Agg. Limit 2,000,000 A Pollution - Occur. PPX1887402 10/01/18 10/01/19 Limit 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Professional Liability Retroactive Date 8/01/87. Excess policy also applies to Pollution and Professional. ***Endorsement to Follow*** The City of Oshkosh and its officers, council members, agents, employees and authorized volunteers are included as additional insured on the general and automobile liability policies when required by written contract. A 30 day notice of cancellation, except 10 days for non-payment will be provided to those parties indicated in the written contract. CERTIFICATE HOLDER CANCELLATION 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. Attn: City Clerk P.O. Box 1130 AUTHORIZED REPRESENTATIVE Oshkosh, WI 54903 g41 „ USA `Q� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD diannewandel 54191150