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HomeMy WebLinkAboutCD Smith 10-1-19 AC DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/10/2019 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 CONTACT NAME: Bridget McCarthy Arthur J. Gallagher Risk Management Services, Inc. PHONEN ext):262 792 2222 (A/c,No):262-792 1712 101 Camelot Drive, Suite 2C E-MAIL Fond du Lac WI 54935 ADDRESS: blidget_mccarthy@ajg.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:The Travelers Indemnity Company of CT 25682 INSURED INSURER B:Great American Insurance Company 16691 C D SMITH CONSTRUCTION INC PO BOX 1006 INSURER C:Phoenix Insurance Company 25623 FOND DU LAC WI 54936-1006 INSURER D:Travelers Indemnity Company 25658 _ INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1982183673 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 SUBR POLICY EFF POLICY EXP LIMITS LTRINSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) C X COMMERCIAL GENERAL LIABILITY Y CO-4H840632 10/1/2018 10/1/2019 EACH OCCURRENCE $2,000,000DAMAGE TO RED CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $300,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY X JE 0 LOC PRODUCTS-COMP/OP AGG $4,000,000 OTHER: $ D AUTOMOBILE LIABILITY Y 810-4H840632 10/1/2018 10/1/2019 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ B X UMBRELLA LIAB X OCCUR Y TUU019530908 10/1/2018 10/1/2019 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$1tLnnn $ A WORKERS COMPENSATION UB4H928501 10/1/2018 10/1/2019 X AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 11 yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) City of Oshkosh,and its officers,council members,agents,employees and authorized volunteers are additional insureds on the general liability,auto liability and umbrella liability policies on a primary and non-contributory basis for both ongoing and completed operations. Policies include a 30 day notice of cancellation to the certificate holder. Project:Annual Excavation License Application CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Oshkosh ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Ave PO Box 1130 AUTHORIZED REPRESENTATIVE Oshkosh WI 54903-1130 (UCtel ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD