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HomeMy WebLinkAboutLueck's Home Improvement 8-1-20 �...., LUECHOM-01 BWEISS ACORD DATE(MM/DO/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 9/24/2019 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 ADD13ARED,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 hole {tJ�tieu of such endorsement(s). PRODUCER License#100290819 OCT 16 l' "J CONTACT Bonnie Weiss Sheboygan,WI Hub International Midwest Limited 2124 Kohler Memorial Drive OF PUBLIC WORKS PHONE,Ext): FAX No): E-MAIL Suite yg DEs WISCONSIN ADDREss:bonnie.weisschubinternational.com_ Sheboygan,WI 53081 OSHKOSH, INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Hastings Mutual Insurance Company 14176 INSURED INSURER 0:American Interstate Insurance Company 31895 Lueck's Home Improvement Inc INSURER C:Lloyd's of London 15792 706 S Main Street INSURER D: Oshkosh,WI 54902 INSURER 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 TYPE OF INSURANCE ADDL SUBRIPOLICY NUMBER POUCY EFF POLICY EXP OMITS LTR INSR WVD IMM/DD/YYYYI IMM/DD/YYYY1 A X COMMERCIAL GENERAL LIABILITY I 1 EACH OCCURRENCE $ 1,000,000 CLAIMS MADE X OCCUR I X CPP9750913 8/1/2019 8/1/2020 DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X 12ei X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: EMPLOYMENT PRAC $ 100,000 A AUTOMOBILE UABWTV COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO ACV9750915 8/1/2019 8/1/2020 BODILY INJURY(Per person) ,$ OWNED ' SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-AWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ A X UMBRELLA DAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS UAB CLAIMS-MADE ULC9750917 8/1/2019 8/1/2020 AGGREGATE $ 5,000,000 DED X RETENTION$ 0 1 $ B WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE PER EERH ANY PROPRIETOR/PARTNER/EXECUTIVE Y I; AVWCW12621732019 8/1/2019 8/1/2020 1,000,000 EACH ACCIDENT $ 1'000'000 OFFICER/MEMBER EXCLUDED? 1N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,descnbe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Pollution ded$2,500 :SPEC0404 9/20/2019 9/20/2020 Per Claim 1,000,000 A Equipment Floater CPP9750913 8/1/2019 8/1/2020 Limit 200,000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) V.Right-of-Way Obstruction/Right-of-Way Annual Excavation/Right-of-Way single Site Excavation!Work in Right-of-Way City of Oshkosh,its officers,council members,agents,employees&authorized volunteers are recognized as Additional Insureds as regards General Liability per form CON6063 1/18&Auto Liability per Form CA2048 10/13. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: City Clerk 215 Church Ave. -- - - Oshkosh,WI 5490 3-1 1 3 0 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD