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OP ID J DATE (MM/DDIYYYY)
CENTR-6 04'04 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.
ACORD~
CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
Regional Insurance Agency
a div of R&R Insurance
N80 W14824 Appleton Ave
Menomonee Falls, WI 53051
J?hone:262::-255-S100 Fax:262-255-4189
INSURED'
INSURERS AFFORDING COVERAGE
INSUREJrA: ACUITY' -INSURANCE COMPANY
INSURER B: TRI STATE INSuRANcE CO
INSURER c:
INSURER D:
INSURER E:
central "Restora tion LLC
"W:7870,East Clark Road
Oakfield WI 53065 ,
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,
L TR NSR[
TYPE OF INSURANCE
GENERAL LIABILITY
-
X COMMERCIAL GENERAL LIABILITY
I CLA1MS MADE ~ OCCUR
POLICY NUMBER
p;a,;!~j,f~rJ;r~IE P~kJfEY(ij~b~J!RN
A
K35685
04/25/06
EACH OCCURRENCE
04/25/07 PREMISES(Ea~~r~nce)
MED EXP (Anyone person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
A
-
~'L AGGRE~E LIMIT AP~S PER:
I I POLICY I I ~~8;: I I LOC
~TOMOBILE LIABILITY
ANY AUTO
-
_ ALL OWNED AUTOS
~ SCHEDULED AUTOS
_ HIRED AUT?S >. '''.
NON-OWNED AUTOS '
'_' PROPERTY DAMAGE
(Per accident) ,,' - ',',.
AUTO ONLY - EA ACCIDENT
EA ACC
K35685
04/25/06
COMBINED SINGLE LIMIT
04/25/07 (Eaaccident)
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
-
-
,
,',
-
;, ','
'"
A
GARAGE LIABILITY
rl ANY AUTO
EXCESS/UMBRELLA LIABILITY
~ OCCUR 0 CLAIMS MADE
:-l DEDUCTIBLE
M RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRiEiORlPARTNERlEXEtUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
OTHER
WC-4 3--02 -, 006014 ""02
06/14/05
06/1.1/06 ' EL. EACH ACCID!ONT $100,000
n, DISEASE - EA EMPLOYEE $ 100 , 000
EL, DISEASE - POLICY LIMIT $ 500 , 000
A Inland Marine K35685 04/25/06 04/25/07 Limit
Scheduled Equipmen Ded
DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVlSI^"" rr::;;: ....
RE' Wasterwater Trea_nt Plant Project, city of Os~ Q !'C'\!'8'~ IS N
~ APR 0 7 2006 lU
l:::J
CANCELL II,; ~_r"'~1.""'C:
CITYOSl SHOULD AN __ ~w>,-l'c(E~ BE CANCeul=-D BEFORE THE EXPIRATIC
DATE THER =. INSURER WILL END'EAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHAll
IMPOSE NO OBLI.GA TION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
OTHER THAN
AUTO ONLY:
K35685
04/25/06
04/25/07
EACH OCCURRENCE
AGGREGATE
X ITS'~Y;;~I~\~S I
B
CERTIFICATE HOLDER
City of Oshkosh
233 North Campbell Road
Oshkosh WI 54902
Greaorv Barnev'
@ACORDCORPORATION 19:
ACORD 25 (2001/08)
NAIC#
U184
LIMITS
$1,000,000
$ 100,000
$ 5; 000
$ 1,000,000
$2,000,000
$ 2,000,000
$1,1000,000
$
.,
$
-
$
- "
$
$
AGG $
$1,000,000
$ 1,,000,000
$
$
$
\oJ~.
28,000
250