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HomeMy WebLinkAboutLiability Ins., Michels Foundations IA35 MICHEO$ OP ID: MJ ACRO' CERTIFICATE OF LIABILITY INSURANCE 7OT6/1812016 E(MMTDDIY 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(los) must 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 Mar-- MiljiC Weible&Cahill 2300 Cabot Drive,Suite 100 wcNo ext}:630-246.4600 FAX No): 630-245-4601 Lisle,IL 60532 E-MAIL Ess: William P.Welble rn.millic@weiblecahill.com INSURERS AFFORDING COVERAGE NAICH INSURER A:Arch insurance Company 11160 INSURED Michels Foundations,a INSURER 8:National Fire&Marine ins Co 20079 division of Michels Corp. 16500 West Rogers Drive INSURERC:ArchlnsuranceCompany 11150 New Berlin,WI 53151 INSURERD: 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. !NSR ADDLSUBR POLICYNUMBER MM1LDICYDIY YY MR071DD ExP LTR TYPE OF INSURANCE LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE 1XI OCCUR X X 41PKG8916307 0210112016 0210112017 PREMISES Ea occurrence $ 300,00 X XCU Included MED EXPAn ( y one person) $ Exclude X Stop Gap Included PERSONAL&ADV INJURY $ 1,000,00 GFN'LAGGREGATE ITMIT APPLIFSPER, GENERALAGGREGATE $ 2,000,00 RO- POLICY T JECT N LOC PRODUCTS-COMPIOPAGO $ 2,000,00 OTHER: S AUTOMOBILE LIABILITY COMEaaaBINED SINGLE LIMIT $ ,2,000,00 7denl A X ANY AUTO 41PKG8915307 02/01/2016 02/01/2017 BOULY I NJURY(Par person) $ ALLOPED SCHEDULED AUTOS AUTOS BDDLYINJURY(Per acadeni) $ XUT =O PROPERTY HIREDAUTOS OS Pedn $ X MCS-9D $ UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 10,000,00 B X EXCESSLtAB CLAMS-MADE 42XSF10013903 02/01/2016 02/01/2017 AGGREGATE $ 10,000,00 DED I X I RETENTM$ 0 $ WORKERS COMPENSATION X IPER 1 OTH- AND EMPLOYERS'LIABILITYSTATUTE _ ER.__ A ANY PROPRiETORfPARTNER/FXECUTIVE YIN 41WC18916107 02101/2016 02101/2017 E.L.EACH ACCIDFNT $_ m 1,0_00,00 OFFICER7,IEMBER EXCLUDED? N/A C (Mandalory In NH) 44WC18916207(NY ONLY) 02/01/2016 02!0112017 E.L.DISEASE-EA EMPLOYE $ 1,000,00 IT yes,describe under DESCRIPTION OF OPERATIONS Wow E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORO 101,Additional Remarks Schedule,may be attached If more space is required) Re: Michels Job# 59859; City Contract 15--24 Riverwalk Construction- Southside Oregon Ave to Dock Yard & Riverwalk East of Oregon Street to Dockside Primary Additional Insured and Waiver of Subrogation on General Liability: See Page 2 *Per CG2010 07/04, CG2037 07/04, CG2001 4/13 CERTIFICATE HOLDER CANCELLATION OSHKO-2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cil of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 1130 215 Church Street AUTHORIZEDREPRE8ENTATIVE Oshkosh,WI 54903-1130 S`a� • ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD NOTEPAD: HOLDERCODE OSHKO-2 MICHF08 PAGE 2 INSUREUSRAME Michels Foundations,a OP ID:MJ Date 06/18/2016 Re: Michels Job# 59859; City Contract 15-2A Riverwalk Construction- Southside Oregon Ave to Dock Yard and Riverwalk East Of Oregon Street to Dockside Primary Additional Insured and Waiver of Subrogation on General Liability: -- City of Oshkosh AECOM Technical Services,Inc. - thein respective officers, directors, members, partners, employees, agents, consultants POLICY NUMBER: 41PKG8915307 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s), Locations Of Covered Operations Any person or organization for whoa you are required in a All Construction Operations of the Named Insured written contract or agreement to include as an additional Where Required by Written Contract insured. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section Il — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for"bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or In part, by: 1. All work, including materials, parts or equip- 1. Your acts or omissions; or ment furnished In. connection with such work, 2. The acts or omissions of those acting on your on the project (othe( than service, mainte- behalf; nance or repairs) to be performed by or on be- in the performance of your ongoing operations for half of the additional insured(s) at the location the additional insured(s) at the tocation(s) desig- of the covered operations has been completed; nated above. or 2, That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 POLICY NUMBER: 41PKG8915307 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided finder the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Opera- Or Organization(s): tions Any person or organization for whom you are required All construction operations of the named Insured where in a written contract or agreement to include as an required by written contract. additional insured. Information required to com fete this Schedule, if not shown above,will be shown in the Declarations. Section 11 -- Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, it! whole or in part, by"your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included In the "products- completed operations hazard". CG 20 37 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 ❑ Policy #I41PKG8915307 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the This insurance is primary to and will not seek additional insured. contribution from any other Insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance;and CG 20 01 04 13 U Insurance Services Office, Inc., 2012 Page 1 of 1