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ACORD", CERTIFICATE OF LIABILITY INSURANCE OP ID 3~ DATE (MM/DDIYYYY)
.' HEYDE-3 09/07/04
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
The Murphy Insurance Group ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Bridgeview Agency LLC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
318 N. Bridge St. P.O. Box 515 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Chippewa Falls WI 54729
Phone: 715-723-8135 Fax:715-723-8138 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: St. Paul Companies
INSURER B: NSI/West Bend Mutual
Heyde Hospitality Inc. INSURER C:
Park Plaza
1 N MainSt INSURER D:
Oshkosh WI 54901
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 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.
LTR NSR[ TYPE OF INSURANCE POLICY NUMBER PD9..1'~¡ri~ró"g~E Pgk!fEY{~~b'1f'~~N LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
-
A X COMMERCIAL GENERAL LIABILITY CK04804669 01/01/04 01/01/05 UAMA\òt: $ 100,000
PREMISES (Ea occurence)
I CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $5,000
¿ Liquor Liability CK04804669 01/01/04 01/01/05 PERSONAL & ADV INJURY $1,000,000
f-- GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREnE LIMIT APPLIES PER: PRODUCTS.COM~OPAGG $2/0001000
II PRO- n Emp Ben. 11000,000
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
f-- $1,000,000
A ¿ ANY AUTO CK04804669 01/01/04 01/01/05 (Ea accident)
ALL OWNED AUTOS BODILY INJURY
; f-- $
SCHEDULED AUTOS (Per person)
f--
f-- HIRED AUTOS BODILY INJURY
$
NON-OWNED AUTOS (Per accident)
f--
- PROPERTY DAMAGE
i: f-- (Per accident) $
GARAGE LIABILITY .., AUTO ONLY - EA ACCIDENT $
. ~ ANY AUTO ' ... OTHER THÀN EA ACC $
. AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 9 1000 I 000
A ~ OCCUR D CLAIMS MADE CK04804669 01/01/04 01/01/05 AGGREGATE $ 9 1000,000
$
~ DEDUCTIBLE $
X RETENTION $10,000 $
WORKERS COMPENSATION AND I T~~YS~~WS I IVElt
B EMPLOYERS' LIABILITY SVU062311302 01/01/04 01/01/05 $ 100,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 100,000
If yes, describe under E.L. DISEASE - POLICY LIMIT $ 500,000
SPECIAL PROVISIONS below
OTHER
A Property CK04804669 01/01/04 01/01/05 - Building 15/000,000
-=O'1-t~4- ~' ,,::, Con ten ts
A Crime CK04804669 .-!¥Fl' /rft,5 1,432,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDO~ 0 T / SrçCT,C1 ~1°tlS w \f¡ 0""
Property coverage includes loss of income. t ,!) ~
\,...') GI. "-"'A..V"-.
~~ 6 1'1(, j I.....
SEP 1 5 2004 ~&
Olf~~' ioG'~{1\'s,
CERTIFICATE HOLDER CA""I'C' L^TdONLt'~ ( II-HI:I-
s~\,ld Vi.- OLiCIES BE CANCELLED BEFORE THE EXPIRATIO~
City of Oshkosh DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
Mr. Edward A. Nokes NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Director of Finance IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
215 Church Ave PO Box 1128
Oshkosh WI 54903-1128 REPRESENTATIVES.
( 'ÄUtA~ED RE~~ZE~/~ .-iA ~ ./
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ACORD 25 (2001/08) U () - @ ACORD CORPORATION 1988