HomeMy WebLinkAboutMonitoring Wells
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,~2-1r-2006 04:21PM FROM-ALPHA TERRA SCIENCE
920-892-2620
T-096 P.002/004 F-08r
",'-"J ,....,............,.. ,
WHER.EAS, the City of Oshkosh has granted to the undersigned the privilege to Install monItoring
wells on City property In conjunction wIth an environmenl.allnvestigaliOn Qfthe property at 11S High Avenue on
property belongIng to the City of Oshkosh as follows:
Tne privilege to Install, maintain and conduct tests of monitorfng wells in the
A1goma BDulevard ParkIng Lot; Grand Opera HOUS9 property at 100 High Avenue;
and High Avenue P~rkin9 Lot at 110 Fa",1 Avenue, OshkoSh, Wisoonsln.
WHEREAS. the parties to this agreement Intend t\'\a~ by acceptance of this privilege the undersignsid'
shall become primarily respon~ible for damages to persen or properlY by reason of lhe granting of the
privilege;
NOW, THEREFORE, in consideration of the City of OshKosh, a MunIcIpal Corporation granting
permIssion to the undersIgned to insi:ClII monitoring wells on Cilyproperty as described above, the undersigned
agrees that it is solely responsible for its actMtles under this agreement. The undersigned hereby releases
the City of Oshkosh from all debt, claims,. demends. damages, actions and causes of actiOl'l whats;oeverwhi(:h
may result from the installation of the monitoring wells by the undersigned. Further, the undersigned agrees to
protect and hold the City of OshKosh harmless against all actions. . claims and demands of any kind or
character whatsoever which may in any way be caused by the activitie.s LInder this agreement by the
undersigned or agents or employees. Further, the undersigned agrees to Indemnify and refund to the City ,1311
such sums which the Clty may be obligated or adjudged to pay, inoludinS the City'S attorney fees and costs, on
suoh actions, claims or demands within 30 days after written request for suoh indemnification, The
undersigned agrees that this paragraph Is to be. liberally construed in favor of tt\e City of OSh1<osh, in
consIderation of the privilege granted by the City under this agreement
This agreement and the privilege cannot be assigned without the wrItten consent of the City of Oshkosh. T"e
prIvilege is subject to all terms and conditions contaIned lp any authorizing resolution adopted by the City of
Oshkosh Common Council, which is incorporated bY reference as if fully recited within this document. By
executing this agreement and by USing the privllege, the undersIgned agrees to fully abide by such terms end'
conditIons, including revocation upon written natice for noncompliance with the authorizIng resolution and lhls
agre~ment.
Dated this I S"'" day of ;::-r.- &
.2006.
~.
And: ~~~
Name & Tille: i).nv# LV fJJ-:;A/'
A~4 P-r= ..("~;J'-,c.~
"'~I
STATE OF WISCONSIN )
WINNE8AGO COUNTY 1
Personally came before me this / /p
} SS.
who executed the foregoing document on behalf of sa'
same.
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Notary PUbliC.t0~k~co..~~T AFI ;'.~~::.c.-:
My Commission: /-,b>- :: -~- ; :
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. 2006, the abolle-named
t meknowntobetheparson(s}
$ and acknowledged 1the
Attachment:
Exhibit A - R.esol. #05-372 an.d attachments of
OshKosh Common Council Meeting 12/13/05.
DECEMBER 13, 2005
05-372
RESOLUTION
(CARRIED 6-0 LOST
LAID OVER
WITHDRAWN
)
INITIATED BY:
GRANT EASEMENTS I ALGOMA BOULEVARD, HIGH AVENUE
AND PEARL AVENUE AREA
ALPHA TERRA SCIENCE
PURPOSE:
PLAN COMMISSION RECOMMENDATION: Approved
BE IT RESOLVED by the Common Council of the City of Oshkosh that the
proper City officials are hereby authorized and directed to grant easements to Alpha
Terra Science and I or Kings Laundry Inc., or their assignees, in the Algoma Boulevard,
High Avenue, Pearl Avenue area, per the attached maps, for the purpose of installing
monitoring wells on City property in conjunction with an environmental investigation of
the property at 118 High Ave., and to execute any and all documents necessary for
purposes of same. Said easements are hereby granted contingent upon the following:
1) The monitoring wells be installed in a manner that is approved by the Department
of Public Works with no modifications or changes in construction procedure
without prior approval by the Department of Public Works.
2) If no longer needed, the wells be properly abandoned and removed in
accordance with City standards and under the direction of the Department of
Public Works.
3) Any problem which may arise as a result of the placement of the wells be the
responsibility of the petitioners to corr~ct in coordinati91"1 with tl1E3 Department of
Public Works.
4) All appropriate permits be obtained prior to the start of placement of the. wells.
5) The wells be modified or removed immediately upon the request of the City.
6) The petitioner secures and submits to the City Clerk a separate insurance policy
which. names the City as an additional insured with a minimum coverage of
$200,000 per person and $500,000 in general aggregate.
7) It is the responsibility of the petitioner to file in a timely manner a new insurance
certificate with the City Clerk upon expiration of an existing certificate. Failure to
do sowill result in the revocation of the easements within 10 days of notice.
8) The petitioner execute a hold harmless agreement'with the City.
1
, , '
. ...... .
Attachtnent to:Rrivilege InStreetAppli.cation , '
Gunderson ,Cleaners, 118 Hi~ Avenue, Oshkosh, W1
The proposed scope of work includes the install~tionoffive monitoring~ehs onCityofOsbkosh ' ,"
property and three small diameter (2-inch) soil borings in High Street. The work is being completed
for an environmental investigation of the fornier' Gunderson,Cleaners facility at 118 High Avenue.
AIl eight planned well and boring locations are shown on Figure 6 and Figure 1. " '
~ :
, Locations for the wells have b~en marked with paint,' and Mr. Ed Potempa of the City of oshkosh
has reviewed the well locations and provided legal descriptions so Easements to the proposed
drilling locatio~ c.an be obtained. ' ' ' ,
," ~ .
. . . .
Each monitoriIig well (MW.,.109,MW'-110, PZ-ll1, MW-112, and MW-113) will beinstailed
using a truck-mounted drill rig with hollow stem. augers. An 8-inch diameter bore~ole will be
advanced to approximately 15 to 35 feet below grade, and a 2-inchdiaineter Schedule 40 PVC
monitoring well will be installed at the borehole base., Filter p'ack sand, and a bentonite clay seal ' '
will be used to isolate the s~eened interVal of the well, per WAC NR141 well construction,code. '
The surface will be completed using a 10-inch diameter flush mounted traffic-weight protectiv~
well cover, wbich will be cemented in place. The well ?over will be :bolted shut, and a locked, ,
,watertight well cap will cover the 2-in6h PVC inside the, steel cover." '
. .. .' .
The boreholes (GP-13, GP-14, and GP-15) will be installed using a2~inch diameter hydraulic push
sampler to a dePth of approximately 16 feet below grade. The borings will be backfilled upon
completion using bentonite clay, an~ the surface will be restored with aSphalt patch to match the
adjacentroad surface. ' '
. . .".. . "
'.. . " '
, '
, Monito;tfug well MW -109' will be iristaIled in the, asphalt parking lot north of the fonner dry
c1e~g facility (Figure 1, Figure 6)., Well MW-110 will be completed in the sidewalk west o,fthe
Opera House at 1 06 High Street (Figure 1, Figure 6). Due to the presence of the gas line, drilling
in the sidewalk is the only viable option. Well PZ-111 will be installed approximately 3 feet east
, , of existing well MW-I04. Both are located in the 10-foot wide grass vegetation strip,immediately ,
south of the: c,?ncrete sidewalk south of High Street Monitoring wells MW -112 and MW-113 will
be completed in the asphalt parking lot of the 115 High Avenue property and south ofmoIrltoriDg ,
well PZ-ll1 (Figurel, Figure 6).' " " ,
, '
Groundwater samples will be collected from the wells until closure offue site is obtained from the
Wisconsm DepartmentofNatural ResoUrces. The ~uration of the sampling will depend on th(~ '
results of thetes:ting, but wi111ikely be necessary for a period of tWo years or 10nger~T11eWDNR
,contact for this project is Ms. Kathy Sylvester at the WDNR Oshkosh office. She can be reached at'
, 424-0399. ' ' '
Upon completion of the groundwatersmnpling, the wells' will be abandoned per NIt 141 code by
filling the PVC with bentonite clay arid restoration of the ground surface with topsoil, concrete, or'
aSphalt, depending uponthe location of the well. ' ' ' '
The drilling contractor is expected to be M & K Drilling of Glen beulah, thefinn that installecl the
wells previously. M & K will become a licensed contractor with the CIty of Oshkosh once w,e are
sure the permit can be obtained and the timing forthe project becomes apparent. ,
" f\'pen\gunderson cleanerS\gull2<?O+O 1 \reports\permittext oct Z005.doc ,
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DISCLAIMER ' ' ,
This map is neither a legally recorded map nor
a survey and'it is not intended to be used as one.
This drawing is a compilation o( records,. data
and information located in various city, county
and state offices and other sources affecting
the area shown and it is to be used for reference'
purposes only; The (:itY o(Oshkosh is not re-
sponsible (or any inaccul"acies herein contained.
, If discrepencies are (ound, please contact the
City of Oshkosh. "
,'Grant' Easements,
Approximate Locations,
o 100 'Feet
.t-
City of Oshkosh Wisconsin
Community Development
, Creat~d by - dpb
" l1J6/05
.11
02-17-2006 04:21PM
FROM-ALPHA TERRA SCIENCE
920-892-2620
T-096 P. 00Sl004 F-,087
A(,urru.. " Co no. I ...- I'" 1"\ I I- VI L.II.U......... . . .....""'_. ,,.,...._- GUNDE-l I (J~/ltl/Uo
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
The McClone Insurance Group ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
150 Ma..:in Street, ste 102 HOLDER.. l'HIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 389 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Menasha Wi 54952
phone: 920-725-3232 Fax: 920-725-3233 INSURERS AFFORDING COVERAGE NAIC#
-
IPlSUREP INSURER A: Clnc:1I'1!\,o),t1, Inlluranco CQmpa1lrlY
Gundersonf, Ine INSURER B:
Aceents, LC LLC INSuRER C:
Gunderson Transportation
41 Main Street INSURER 0:
Menaeha WI 54952
INSURER E:
COVERAGES
THI::: POLICIES OF INSURANCE LISTED BeLOW ~IA.VE BEEN ISsuED TO THE INSURED NAMED ABOvE FOR T~IE POUCY PERIOD INOICATED. NOTWITHSiANOllIIG ~
AJlY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMeNT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSuEO OR
MAY PeRTAIN. TI'IE INSURANce AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SuBJECT TO ALL THE TERMS. EXCLUSIONS AND CONOITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDuCE:D BY PAID CU\IMS.
~~~ rrf~! TYJ'E OF IN$tJ1UNCE pOLICY NUMBER . \lE~ P-O~!,!',,,T/~~,!ft~1\I LIMITS
DATe iMMIODIYVI- DATli M /pof'{Y
GENERAL LIABILI'rY EACH OCCURRENCE S 1000000
- 'Rel\llt:l.l
A ~- ~MERCIAL GENERAL LIABILI1Y CPP0717543 12/28/05 12/28/06 PREMlsESJEe Dcc~ronQol !t 500000
. CLAIMS MADE 1.1[1 OCCUR MED EXP (Anyone pen;01ll $ 1(1000
- pERSONAl. & ADV INJuRY $1(100000
~
.~ - - . GaEAALAGGREGI\.1E I IS I
I
~'L AGGREGATE LIMIT APPLIes PlR PRODUCTS-COMP~PAGG $ 2000000
n .PRO- ..r=Y -
POLICY JECT LaC
AUTOMOBILE LIABILITY COMBIN8> SINGLE LIMIT
A ~ ANY AUTO CAP 77 1 0 811 12/28/05 12/28/06 lea ~~dd,,"l) $ 1ClOOOOO
- ALL OWNI:::D AUTOS BODILY INJURY
SCI'IEDULED AUTOS (Per por$on) $
-
- HIRED AUTOS 80011.'1' INJURY
NON.OWNED AUTOS (Per llt:~I~anl) $
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..!... .$100 Ded - COMPREHENSIVE PROPER,.." DAMAGE
X $500 Ded COLLISION (Per ect:ldonll $
=iAGli LIABILI1''Y' AUTO ONLY. i:::A ACCIDENi $
ANY AUTO OTI'IER THAN EA ACe $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY i:::ACH OCCUR~ENCE $ 10000000
A ~ OCCUR D CLAIMS MADE CP1;>0717543 12/28/05 12/28/06 AGGREGATE $1()000000
"
$
---
;=! DEDUCTI9LE $
- -
X RETENTION $10000 $
WORKliR5 COMPENSATION AND X I TORy LiMITS I IO~'"
EMPLOVERS" LIABILITY
A ANY PROPRIIOTORlPARTNERlEXECUTIVt:! WC1910312 12/28/05 12/28/06 B.L. EACH ACCIDENT $ 100000
-
OFFICER/MEMBER EXCLUDED? E.L. DISr:ASE . EA EMPLOyee $100000
~~~~~~~V~~~~ below E.l.. OlSeASE~POLICV LIMIT' $ 5()OOOO -
OTHER
I
DESCRIPTION OF OPERATIONS/LOCATIONS / 1IE~IlCLES I EXCLU510NS ADDEO BY ENDORSEMENT 15PECIAL PROVISIONS
The C.:ity of Oshkosh, and .:its officez;s, counc.:il msmbers, agents, employees,
and autho~ized volunteers are included as an additional .:insured under
General Liability as the.:ir interest may appear.
CERTIFICATE HOLDER
CANCELLATION
OSHK002
SHOULD AK'i OF THE ABOVE DESCRIBED pOLICIES BE CANCELLeD BEFORI::: THE EXPIRATIOI
DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAil ~_ DAYS WRITTEN
NO'l'lcE TO TioIE CERTIFlCA'I'E HOLDER NAMED TO 'l'HE LEFT. BUT FAILURE TO DO SO SHALL
IMPOSE NO OElLlGATION OR LlAalUTY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENT A TIllES.
A Rl.li ~EP SENTA
("~
City of Oshkosh
Attn: Off~ce of Clerks
P.O. Box 1130
Oshkosh WI 54902
@) ACORD CORI'ORATION 1981
ACORD 25 (2001/08)
02-17-2006
04:22PM
FROM-ALPHA TERRA SCIENCE
920-892-2620
T-096
P.004/004
F.,087
ACORD.. CERTIFICATE OF LIABILITY INSURANCE OP 10 .9~ PA 1F. (r;lMIDDIVYYY)
,u.!!'1tA :3 02/17/0tl
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF' INFORMATION
Hurkart-Heiadorf Insurance ONLY AIIID CONFERS NO RIGHTS UPON THE CERTIACATE
www.bu~~a=~-h~~~4or~.eom NOLDER. THIS C8R"IOIl::ATE DOES NOT AtJllilllD, EXTEND OR
~G07 2r16 Av6ftua ALTER THE cOVERA~E AFFORDED E:lV THE POUClES BELOW.
Sheboygan WI 53081
rnonc;~ZO-~~e-~17~ IN:;U"I!~S AFFORDING c;oVI!AAGI! ('lAIC U
INSURED INS\JRERA: C1ncinnat~ xnsurance
n"'~Vf'(f;r<1:I -
~J.~hA Terra Science, Inc. I~ISURER c:
Do !!ecker
~i~ff~~t~IP~~~,~m ao~d I.II::um:I1D
INSURER E
COVERAGES
THE POLICIEs OF IN$uI'lANtE LISTED BELOW (-lAVE: BEEN 166UED TO THE INSURED NAMeD MOvE FOn THE: POLICY PERIOD INDICI\'1'F.O 1>l0lWiTl-ISTANDINC
/IN'( REQUIREhl~N'l', -n;:AD.1 OR CONOITION OF /IN'( CONl'1U\CT OR OTHER DOCUMENTWm-1 R~:SP~CT TO WtllCH THIS CERTIFICATE I"^" 8E I&SlIEO OR
MAY PERTAIN, Tl-IE I NSlIlANCE AffORDED BY Tl-lS POLitiES OE~RlaEO HE:REINIS SUBJECT TO ALL THE TERMS. EXCLUSIONS /\ND CONDITIONS 01' SUCH
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CEIIIERAL UAaIU1Y EACH occuAAEIlICE: f.1000000
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CLAlMS MADE ~ OCClIR r.lEO EXP (A..y "'101 poll:WlIl $ 10000
PERSDNAL & />DV INJUR.Y $ 1000000
GIXRAL AClGRCOATC ~ 2000000
<:Fl>rl ^<:G::PF<:^TF I "",,'I' AI'''', ,~~ ~l:P ""'I'\I'lIl~~ l:OI>IPIOP ''''1< I; 2000000
h ..U....IU., rI t;;ltl.h ~..""u ""U\P p..:::'r1_ .....uuuU'c,,)u
AUTOMOBILE LIAeILI1Y COI"'~I"'I=.U l:iINc.;LI=. L1MII
f-- $ 1000000
A ANY AUTO CPA0919019 01/29/06 01/29/07 (6.. ~ccIQent)
f--
f-- ALL OI/llIlCO AuTO!: FlrlnJl Y IN,IIIRY
t
~ SCHEOU~1l AUTOS (""""""""11"1")
~ ~IIRED AUTOS n()PI~V IN..UI1Y
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l"t<ul't.KI Y UAMAOt:. ~
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QA"'AQ= UAlilIUTT "VI V VI'll.' .C'J< J\L.L.IUt:'" I ~
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AUTO ONl,V, ,IU\> 'Ii
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b "I'.rJIQ o (':\ A'IIl<: MAnF Ar.:m:rr-l'..ATF $
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n DI:PUCTIOLI: $
p,l:'l'eNTIOJII m s
WQRKliR~ I;DMI">=lol""TlON AND l~y7.T~~~\};: I j"ER
- ;lMPLOVIiiRS' LI~l"ITV W'CI':"'~.:Lbb.'~U:L 1'Ja.~;a..:;~rut.:l U:L/""'iIl"~.' . ^(~I ^n"nu HI '" ~UU\.i'UU
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OrrlaCJ'VhIChlDC" ~Q..""~!:'OI'" 1;.... I..n~~.e. -E:I\.t:.MI>'I..CJ'I'1';J::. ~ :500000
If ~is. 005CriDC unddl 1::.L. Ullit:,Al:;1: . "Olley LIMII !Ii 500000
:) ECIA" PROVISIONS boloW
OTHER
A Propert.y /3cc'C.:i.on CPPOSl~BO~51 01/Z9/06 01./29/07
DE6CRlPllON OF OPERAlIClNS II.Qc;AllON$/ Vi:"'I~LE9. J EXCLU!lION6 ADDED BY ENDQR5EMENT I $P~O:IAL- P~OVI!lION&
C1.ty or Ot;;nJI;osJ1 l.G recogn1zeC1 ali> an aC1C11.t1.onal. l.nsux:eC1 ror qenElra1 1.1.~1.1.1.ty
.i.n;z;""'.iJ...rdoi: to wo&'k p8;Z;~O;z;m,gd. by A1pb:& Terra S=.1.anca :tnc;!.
CERTIFICATE HOLDER
CANCELLATION
0;5HK-02
t.Wf.:'lULD AN.., '-'~ -n.I~ .AJ:I.oVIi!. ~4t~A:lIiiII;;'D PDLICIC:'C- ali CA.N.;-J;LUii;D Iili3=000LIiiii: ~Iiii/ !:DcJ!t1AA ~N
DATE lliERECF. lHC (:sWINe lilfeu~ WJ1.L ENClEAI/OR TO MAL 'r]QlL DAn wRITT1iiN
NOlleli TO THIii C'iiii:~"l1JI'Jt;A'1li MOLCIiA ~Miil.'3 TD,.,..II: UCJ='T, 8UTFA,lLUFUi= TO DO so ro.MALL
IMPClti; ilia ",,,ue^,nON OQ LI^RItJiY QI' ANV O<INfl UPON llolli 1OI~I,IFl"R, n... Am:NT<<! O~
c:i T".V <':I'" n..l'u::C"l~"
At::tn:: Lynn :z:.o~~n.!:lon
F.O. Box 1130
215 Churoh Avcn~~
O~hkgsh W% S4~02-1130
1'I;1:i~C1J::NTA"V~Z1.
AUIHUKlL.t:."" KtIi,..~I;ii~N IAIIVt::
ACORD 25 (2001/08)
Andrew G. Burkart, CPCU. RHfJ
@ A~ORD CORPORATION 198~
ACORDN
CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
Burkart-Heisdorf Insurance
www.burkart-heisdorf.com
1807 Erie Avenue
Sheboygan WI 53081
Phone: 920-458-6174
INSURED
OP ID Sl DATE (MM/DDNYVY)
ALPHA-3 02/17/06
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
IIIAIC#
Alpha .Terra SCience,.. Inc.
Don :seeker. .... '. ,'.. .
1237 South Pilgrim Road
Plymouth WI 53073
INSURER A:
INSURER B: .
INSURER C:
INSURER 0,
INSURER E:
Cincinnati InSurance
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 ~~';!~TM~rD1f~E P9!-L<<;Y(FP/RAT~)N LIMITS
DATE MM/DDNY
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
r-- 01/29/06 01/29/07 I PREMISES (Ea occurence)
A X COMMERCIAL GENERAL LIABILITY CPP0918019 $ 500000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 10000
PERSONAL & ADV INJURY $1000000
-
GENERAL AGGREGATE $ 2000000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $2000000
I 'nPRO- n Emp Ben. 1000000
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000
r--
A ANY AUTO CPA0918019 01/29/06 01/29/07 (Ea accident)
r--
ALL OWNED AUTOS BODILY INJURY
- $
X SCHEDULED AUTOS (Per person)
-
~ HIRED AUTOS BODILY INJURY
. . .,., (Per accident) $
X NON-OWNED AUTOS .... -. .... .
. ~ c '."0"". '.'
.... , ,.' '. ... PROPERTY DAMAGE $
" ':,.',' ,:,:i.>. ",X\.F. . (Per accident)
.. '. .'" ',,' AUTO ONL Y ~ EA ACCIDENT $
GARAGE LIABILITY.. ..
q ANY AUTO" ~,;;.
OTHER THAN EA ACC $
AUTO ONLY, AGG $
EXCESs/UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR o CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TORY L1M1Tl3 I IUER-
A EMPLOYERS' LIABILITY WC191887201 01/29/06 01/29/07 EL. EACH ACCIDENT $ 500000
ANY PROPRIETOR/PARTNER/EXECUTNE
OFFICER/MEMBER EXCLUDED? .-, EL. DISEASE - EA EMPLOYEE $ 500000
If yes, describe under
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500000
OTHER
A Property Section CPP0918019 01/29/06 01/29/07
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
City of Oshkosh is recognized as an additional insured for general liability
in regards to work performed by Alpha Terra Science Inc.
CERTIFICATE HOLDER
CANCELLATION
OSHK-02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Oshkosh DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL TEN DAYS WRITTEN
Attn: Lynn Lorenson NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
P.O. Box 1130 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
215 Church Avenue
Oshkosh WI 54902-1130 REPRESENTATIVES.
AUTHO~EDREPRESENTATNE
Andrew G. Burkart, CPCU, RHU
ACORD 25 (2001/08)
@ ACORD CORPORATION 1988
-,;.-;,..",