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Home My WebLink About234 Campbell Road ---.....-... - I '~" i$' . DATE (MMIDDIYYYY) " ACOBlt CERTIFICATE OF LIABILITY INSURANCE 04/11/2005 PRODUCER (?t)52)545-1230 FAX (952)593-8733 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Am~rican Agency Inc ONLY AND CONFERS NO RIGHTS UPON tHE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 5851 Cedar lake Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POBox 16527 Minneapolis, MN 55416-0527 INSURERS AFFORDING COVERAGE NA1C# INSURED Nieman Central Wisconsin Roofing Co Inc INSURER A: United Fire & Casualty B021 N 2599 24th Ave INSURER B: American Interstate Ins Co 31895 Lyndon Station, WI 53944 INSURER c: INSURER 0: INSURER E: -' 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DO' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY 60064324 05/01/2004 05/01/2005 EACH OCCURRENCE $ 1,000,000 I-- X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 ~ CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $ 10,000 A ~ Employee Bene Liab PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 - GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 Xl POLlCY n ~~8T n LOC AUTOMOBILE LIABILITY 60064324 05/01/2004 05/01/2005 COMBINED SINGLE LIMIT - $ X ANY AUTO (Ea accident) 1,000,000 I-- ALL OWNED AUTOS BODILY INJURY I-- $ SCHEDULED AUTOS , (Per person) A I-- HIRED AUTOS BODILY INJURY - $ NON-OWNED AUTOS (Per accident) - - PROPERTY DAMAGE $ (Per accident) R"'G' UAB,em AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY 60064324 05/01/2004 05/01/2005 EACH OCCURRENCE $ 3,000,000 :K:l OCCUR o CLAIMS MADE AGGREGATE $ 3,000,000 A $ ~ DEDUCTIBLE $ X RETEHTION lO,OOIJ ,', $ $ WORKERS COMPENSATION AND AVWCWII095952003 05/01/2004 05/01/2005 X 1 T~%~T~1~,J -IOJb'- EMPLOYERS' LIABILITY 1,000,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E,L DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under 1,000,00(] SPECIAL PROVISIONS below EL DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS' VEHICLES' EXCLUSIONS ADDED BY ENDORSEMENT' SPECIAL PROVISIONS ertificate Holder is additional insured regarding project @ 234 Campbell Road, Oshkosh, WI. )wner: City of Oshkosh, 215 Church Ave., Oshkosh, WI 54901 COVERAGES Roofing Design & Solutions, Inc. 3701 East Evergreen Drive Appleton, WI 54913 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMEIl TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY CERTIFICATE HOLDER ACORD 25 (2001/08) b~ I\n . .' . I @ACORO CORPORATION 19. ~YU(W ttrJ-lr {ljf\~ (ULb ~C1 ' OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHO~EPRESENTATIVE R Donald Eddy/MKJ i,' ,..", ~M CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDNYVY) 04/15/2005 PRODUCER (.952)545-1230 FAX (952)593-8733 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION AmE!r;can Agency Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 5851 Cedar lake Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POBox 16527 Minneapolis, MN 55416-0527 INSURERS AFFORDING COVERAGE NAIC# INSURED Nieman Central Wisconsin Roofing Co Inc INSURER A: United Fire & Casualty 13021 N 2599'24t:h Ave INSURER B: American Interstate Ins Co 3:1895 Lyndon Station, WI 53944 INSURER c: INSURER D: INSURER E: COVERAGES 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 TI-IIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR DD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY 60064324 05/01/2004 05/01/2005 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 I CLAIMS MADE m OCCUR MED EXP (Anyone person) $ 10,000 A X Employee Bene Liab PERSONAL & ADV INJURY $ 1,000,000 - GENERAL AGGREGATE $ 2,000,000 - GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 Xl n PRO- nLOC POLICY JECT AUTOMOBILE LIABILITY 60064324 05/01/2004 05/01/2005 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ r-- 1,000,000 ALL OWNED AUTOS BODILY INJURY I t-- $ SCHEDULED AUTOS (Per person) A t-- HIRED AUTOS BODILY INJURY t-- (Per accident) $ NON-OWNED AUTOS t-- PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ==1 ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY 60064324 05/01/2004 05/01/2005 EACH OCCURRENCE $ 3,000,00Cl :K:l OCCUR D CLAIMS MADE AGGREGATE $ 3,000,00Cl A $ ~ DEDUCTIBLE $ X RETENTION $ 10,00( $ WORKERS COMPENSATION AND AVWCWI1095952003 05/01/2004 05/01/2005 X I WC STATU- I IOJ~- " , EMPLOYERS' LIABILITY $ 1,000,00Cl B ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1,000,00Cl If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1, 000, OQ(J SPECIAL PROVISIONS below OTHER " IfcESCRIPTION OF OPERATIONS / LOCATIONS' VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT' SPECIAL PROVISIONS oofing Design & Solutions, Inc. is additional insured as respects the Named Insureds operations for General Liability @ 234 Campbell Road, Oshkosh, WI. Pwner: City of Oshkosh DER City of Oshkosh 215 Church Ave. Oshkosh, WI 54901 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ~ R Donald Edd /MKJ ACORD 25 (2001/08) @ACORDCORPORATION1988 ----.