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A COR~M CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDJYY)
09/13/2004
PRODUCER (920) 739-7711 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 877 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Appleton, WI 54912-0877
INSURERS AFFORDING COVERAGE
INSURED Mechanical Technologies Inc INSURER A: Renent Insurance Co
POBox 12176 INSURER B: General Casualty Co of WI
Green Bay, WI 54307-2176 INSURER c:
INSURER D:
I INSURER E:
..
MECHTEC-O1
CLCS
COVERAGES
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THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE ¡=ÓR tHE ÞOLlCY ÞERiODINDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONÓjTióNÖÞANvCÓNTRAC'fÖR:OfHERÓOC(jMÊNf WiTH RESPECt TO WHICH THIS CERffÞfcATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY tHE POLICIES DESC~IßE[) HEREIN IS SUBJECT fo ALL tHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVEßEÊN RÊDOêËbSYPAiöêLAIMS.
IN~: TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE PQl!fLY EXPIRATION LIMITS
~NERAL LIABILITY I EACH OCCURRENCE $ 1 OOO.OO(
A X COMMERCIAL GENERAL LIABILITY CCI0281343 09/11/2004 09/11/2005 FIRE DAMAGË (Anv one fire) $ 100 OO(J
I CLAIMS MADE [X] OCCUR MED EXP (Anyone person) $ 5.00(
- PERSONAL & ADV INJURY $ 1 000 OO(
- GENERAL AGGREGATE $ 2 OOO.OOc]
~'L AGGRE~E LIMIT APMS PER: PRODUCTS-COM~OPAGG $ 2000 OOC]
POuCY X ~§-,Q;: LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,OOO,OOc]
B X ANY AUTO CBA0281343 09/11/2004 09/11/2005 (Ea accident)
- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
-
X HIRED AUTOS BODILY INJURY
$
X NON-OWNED AUTOS (Per accident)
--'- PROPERTY DAMAGE
(Per accident) $
~RAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $ 5000 000
A i=x]-OCCUR D CLAIMS MADE CCU0281343 09/11/2004 09/11/2005 AGGREGATE $ 5000000
$
~ DEDUCTIBLE $
X RETENTION $ 10000 $
WORKERS COMPENSATION AND xl TVj,~§T{,;1.lI:-" I IOJ,tI-
A EMPLOYERS' LIABILITY CWC0281343 09lH/20Ô4 09/11/2005 ." 100 OO ]
EL. EACH ACCIDENT $
EL. DISEASE - EA EMPLOYEE $ 100 OOIJ
E.L. DISEASE - POLICY LIMIT $ 500 (}O(
OTHER
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DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ~~ L!::2 \\:Ð \-'" u y
Commercial General Liability Coverage Includes a Blanket Additional Insured Endor ~
SEP 1 5 2.004
Re: Oshkosh Waste Water Treatment Plant, Monorail Crane System
- .......,¡f'e" n¡;;'1-1I 'I- \
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION rn '( ~". ~
SHOULD ANY OF THE AB VE"DËSCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Oshkosh DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL~DAYS WRITTEN
POBox 1130 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Oshkosh, WI 54902-1130 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE .# . z ..~. ,f
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ACORD 25-S (7/97)
@ACORD CORPORATION 1988