HomeMy WebLinkAboutCert of Liability Insurance- Vinton Construction A 7E(MM/DDtYYYY)
��L> CERTIFICATE OF LIABILITY INSURANCE 9/24/2018
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 pollcy(les) 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: Tiffanie Courtney
M3 Insurance Solutions, Inc. PHONE a480 Pilgraim Way, Suite 1230 (A/C. 920-455-7102
E-MAIL
Green Bay WI 54304 ADDRESS: tiffanie.courtnevam3ins.com
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:Zurich American Insurance Co. 16535
INSURED VINTCON-01 INSURER B:American Guarantee&Liability 26247
Vinton Construction Company INSURER C:Starr Indemnit and Liability
2705 North Rapids Road
PO Box 1987 _INSURER D:
Manitowoc WI 54220-1110 -INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:308525870 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 ADDLSUBR POLICY EFF POLICY EXP
_LTR TYPE OF INSURANCE IN SO WVD POLICY NUMBER (MMIDDrYYYY) (MM1DDfYYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY GLO-5948754-04 3/1/2018 311/2019 EACH OCCURRENCE $1,000,DOO
CLAIMS-MADE FXI OCCUR -f5AMA`GrT6_RTNTE_D
-EBE-41 a)_SES(Eaoccurrenc $300,000
.Mff�_EXP(�U_one person qc
rX XCU Cov,Incl, PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
I
POLICY JECT
X PRO-
X LOC PRODUCTS-COMP/OP AGO $2,000,000
MN
OTHER: $
-59487 , ,A AUTOMOBILE LIABILITY BAP 53-04 3/1/2018 3/1/2019 (CEO, c.MBINk:En)t)_SINGLE LIMIT $i 000 Goo
.................
X ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY $
B X UMBRELLA LIAR X OCCUR AUC-5948802-04 311/2018 3/112019 EACH OCCURRENCE $10,000,000
EXCESS LIAR CLAIMS-MADE AGGREGATE $10,000,000
D D I X I RETENTION$0 $
WORKERS COMPENSATION WG-5948756-04 311/2018 3/1/2019 1 OTH-
AND EMPLOYERS'LIABILITY YIN STATUTE I ER
ANYPROPRIETORIPARTNER/EX1 1vc E.L.EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? N NIA
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 if yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,0DO, )0
C Leased/Rented Equipment ITC100070342618 3/1/2018 3/112019 Leased/Rented 665,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
Public Works Contract#18-14
Additional Insured On The General Liability and Automobile Liability City Of Oshkosh,And Its Officers,Council Members,Agents, Employees And Authorized
Volunteers As Respects The Work Being Done Per Blanket Additional Insured Endorsement,As Required By Written Contract, Umbrella is Follow Form.
Endorsed Policies Will Include A 30 Day Notice Of Cancellation/Nonrenewal For Any Reason Other Than Nonpayment Of Premium,Provided To Those Parties
Indicated In The Written Contract.
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.
Attn:City Clerk
215 Church Avenue, PO Box 1130 AUTHORIZED REPRESENTATIVE
Oshkosh WI 54903-1130
1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD