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HomeMy WebLinkAboutMike Koenig Construction 8.1.19 - ^ RI -- 1 e DATE(MM/DD/YYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE ,cr-r) 1/28/2019 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. '' UkJ14\11,, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVE'lh ublect 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: Kristl Elchman Ansay&Associates, LLC PHONE FAX 101 East Grand Ave, Suite 11 (A/C.No.Eat);262-376-3261 _ (A/C,No):262-387-8061 Port Washington WI 53074 ADDRESS: Kristi.eichman@Ansay.com — INSURER(S)AFFORDING COVERAGE NAIC 8 INSURER A:ACUITY,A Mutual Insurance Company 14184 INSURED MIKEKOE-02 INSURER B: Mike Koenig Construction. Inc. 3502 Behrens Pkwy INSURER C: Sheboygan WI 53081 INSURERD: _ INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:239264742 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 SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MMIDD/YYYY) (MM/DDIYYYY) A GENERAL LIABILITY Y X48792 8/1/2018 8/1/2019 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $300,000 _ CLAIMS-MADE X OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $3.000,000 7 POLICY JET LOC $ elA AUTOMOBILE LIABILITY X48792 8/1/2018 8/12019 COMBINED SINGLE LIMIT (Ea accident) $1.000,000 X I ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X PROPERTY DAMAGE NON $ AWNED (Per accident) AUTOS A UMBRELLA LIAB X OCCUR X48792 8/1/2018 8/1/2019 EACH OCCURRENCE $6,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED X RETENTION$0 $ A WORKERS COMPENSATION X48792 8/1201B 8/1/2019 WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETORJPARTNER/EXECUTIVE E.L.EACH ACCIDENT _$100.000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE$100.000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 A X48792 8/1/2018 8/1/2019 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101.Additional Remarks Schedule,If more space is required) City of Oshkosh,and its officers,council members,agents,employees and authorized volunteers are additional insured on a primary and non-contributory basis for completed operation on the general liability as required by written contract per the attached endorsements.30-day notice of cancellation applies with an endorsement to follow. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 411 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Kti,(1430 City of Oshkosh 215 Church Avenue AUTHORIZED REPRESENTATIVE Oshkosh WI 54903-1130 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD