HomeMy WebLinkAbout20th Ave/Monitoring Wells
ACORD", CERTIFICATE OF LIABILITY INSURANCE CSR MJ I DATE (MMIDD/YYYY)
MURP-01 OS/22/06
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Uni ted Insurance Agency Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
116 W. Elm - P.O. Box 1604 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
E1 Dorado AR 71731-1604
Phone: 870-863-4123 Fax: 870-862-6.956 INSURERS AFFORDING COVERAGE NAlC#
INSURED INSURER A: LIBERTY MUTUAL FIRE INS. CO.
INSURER B:
Mu;,rph~ Oil USA, Inc, INSURER C:
John . Dumas 6 Risk Manager
P. O. Box 700 INSURER D:
E1 Dorado AR 71731-7000
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 OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BYTHE 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.
L TR NSR[ TYPE OF INSURANCE
~NERAL LIABILITY
A X COMMERCIAL GENERAL LIABILITY
I CLAIMS MADE ~ OCCUR
POLICY NUMBER
~<i,;!H~~rJ8JW' P8k~1:"tW,b~~N
LIMITS
RG2-641-004245-026
06/01/06
06/01/07
EACH OCCURRENCE
p~lS~s lEa occurencel
MED EXP (Anyone person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS-COM~OPAGG
$ 500 ,000
$100,000
$5,000
$ 500 I 000
$ 500 ,000
$ 500 I 000
-
I---
GEN'L AGGRErGlATE LIMIT APPLIES PER:
!--l PRO- n
I I POLICY JECT LOC
AUTOMOBILE LIABILITY
I--
ANY AUTO
-
ALL OWNED AUTOS
COMBINED SINGLE LIMIT $
(Ea accident)
BODILY INJURY $
(Per person)
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $
(Per accident)
-
SCHEDULED AUTOS
-
HIRED AUTOS
-
NON-OWNED AUTOS
-
I---
GARAGE LIABILITY
==1 ANY AUTO
EXCESSJUMBRELLA LIABILITY
:=J OCCUR D CLAIMS ~E
RDEDUCTIBLE
RETENTION $ .
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUr)~IJ?- -- -
If yes, describe under
SPECIAL PROVISIONS below
OTHER
EACH OCCURRENCE
AGGREGATE
AUTO ONLY - EA ACCIDENT $
EAACC $
AGG $
$
$
$
$
$
OTHER THAN
AUTO ONLY:
I WCSTATU. I OTH-
I TORY LIMITS ER
E.L. EACH ACCI[)E:NT $
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
CERTIFICATE HOLDER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS _ ,
For insta11ati~n of monitoring wells withi.n the public r\1ij. .-~W~.~~~J7 ~l~ r:'
20th Avenue adJacent to 218 & 225 W. 20th Avenue. R.- ~ '.;;;-;:;' U:;:, ~,. ~.,:;;"\\
, }',:---- Ii! 1\
. i\n \ JUN 0 520GG I\UJ
CANCELLA TIO IiJ , I ,.. .... I
OSHKOSH SHOULD ANY OF 1 ~Et}l"PfE0eiRtSCti ...... : _ ~~EfORE THE EXPIRATlm
DATETHEREOF,l1~~rr:NDEAVORTOMAlL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
Ai2!~~NT~.. .
City of Oshkosh
Warren P. Kraft, City
215 Church Avenue
P. O. Box 1130
Oshkosh WI 54903-1130
Attorney
ACORD 25 (2001/08)
@ACORD CORPORATION 1988