HomeMy WebLinkAboutM&K Environmental & Soils Drilling LLC
TREMPE INSURANCE AGENCY, INC
1452 N 43RD STREET
SHEBOYGAN, WI 53081
DATE (MM/DDIYY)
04/10/2006
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
INSURED
COMPANY
A
ACUITY
M & K ENVIRONMENTAL & SOILS DRILLING LLC
PO BOX 216
GLENBEULAH, WI 53023
COMPANY
B
COLONY
COMPANY
C
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 B Y 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.
CO POLICY EFFECTIVE POLICY EXPIRATION
LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DDIYY) DATE (MM/DDIYY) LIMITS
GEIIIERAL"L1All1I.JTY 003746 2-12-06 2-12-07 GENERAD~iGGREl3ATE $ 1,000,000
A X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG $ 1,000,000
CLAIMS MADE [K] OCCUR PERSONAL & ADV INJURY $ 1,000,000
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ '1,000 000
FIRE DAMAGE (Anyone fire) $ 100,000
MED EXP (Anyone person) $ 1,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ -1,000,000
A ANY AUTO
ALL OWNED AUTOS BODILY INJURY $
X SCHEDULED AUTOS 2-12-07 (Per person)
HIRED AUTOS $
NON~OWNEDAOtdg0:J ,'".
$
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY 003746 2-12-06 2-12-07 EACH OCCURRENCE $ 4,000,000
A X UMBRELLA FORM AGGREGATE $ 4,000,000
OTHER THAN UMBRELLA FORM $
OTH-
WORKER'S COMPENSATION AND 0003746 2-12-06 2-12-07 ER
A EMPLOYERS' LIABILITY $ 100,000
THE PROPRIETOR! X INCL $ 500,000
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE $ 100,000
OTHER EACH CLAIM $1,000,000
B POLLUTION LIABILITY CP203691 3-17-006 3-17-07
AGGREGATE LIMIT $1,000,000
DRILLING
THE CITY OF OSHKOSH, OFFICERS, COUNCIL fv1~fv1BERS, AGENTS, EMPLOYEES AND AUTHORIZED VOULENTEERS ARE NAMED AS
ADDITIONAL INSUREDS.
CITY OF OSHKOSH
215 CHURCH STREET
OSHKOSH, WI 54901
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIJ\BILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
LESLIE R. TREMPE
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