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ACORDN CERTIFICATE OF LIABILITY INSURANCE OP ID K~ DATE (MM/DDIYYYY)
90SHTRK 03/30/06
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Hays Companies of WI HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1200 N. Mayfair Road Suite 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Milwaukee WI 53226
Phone: 414-443-0000 Fax:414-259-844B INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Scottsdale Insurance Company
INSURER B:
Oshkosh Truck co~oration INSURER C:
2307 oreaon St'3 0 Box 2566 INSURER 0:
Oshkosh I 5490 -2566
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.
NSRI TYPE OF INSURANCE POLICY NUMBER PD~,;!~1J~rJ~~E PQL!Y:YIIEXPI~~N LIMITS
LTR DATE MM/DD
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
f---
A X X COMMERCIAL GENERAL LIABILITY RBSOOO1157 04/01/06 04/01/07 U"IVIA"'t:~ $ 500,000
PREMISES (Ea occurence)
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $
PERSONAL & ADV INJURY $ 1,000,000
-
GENERAL AGGREGATE $ 5,000,000
-
GEN'L AGGREGATE LIMIT APnS PER: PRODUCTS - COMP/OP AGG $ 2 , 000 , 000
Xl .n PRO-
X POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- (Ea accident) $
ANY AUTO
f--
ALL OWNED AUTOS BODILY INJURY
f-- (Per person) $
SCHEDULED AUTOS
f---
HIRED AUTOS BODILY INJURY
f--- (Per accident) $
NON-OWNED AUTOS
f--
f-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EAACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
tJ OCCUR D CLAIMS MADE ,..-----* r::;;;;-~.n ~ ~f;\ AGGREGATE $
fIT ~' ( $
G' ~ t~:'J, -:.,; ~;'_-j
R DEDUCTIBLE 1-0:-...-..-......----.. \h '\ $
;! .nr -- '. ~ i;
RETENTION $ \ ~ l t $
\l\I\ ~PI o a 2GGb .., H- I TORY LIMITS I IOJit
WORKERS COMPENSATION AND H\ i I I
EMPLOYERS' LIABILITY Ii :,,, I \ E.L. EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTIVE .'1,;.,,,,,1
OFFICER/MEMBER EXCLUDED? 'iCE \ E. L. DISEASE - EA EMPLOYEE $
If yes, describe under ("',TV (:1 r""t"'!!.fIS 01=1 E. L. DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below t:.r~>t t<+. !};~, - 'v(;f II;
OTHER .... ~~;;""\~tl<...,~;'fit":/f!;'l'Il\"~"" .....
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
RE: Application - communications conduit being installed under W Waukau
Avenue in two locations at the 370 W Waukau Avenue property owned by Oshkosh
Truck Corporation. City of Oshkosh is included as an additional insured but
only with respects to liability arising out of Oshkosh Truck Corporation's
operations subject to the policy terms, forms,conditions & exclusions
OSHKOS
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO~
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ 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. !
AUTHORIZED REPRESENTA
@ACORDCORPORATION198E
CERTIFICATE HOLDER
City of Oshkosh
City Clerk-City of Oshkosh
Attn: Angela Joeckler
215 Church - POBox 1130
Oshkosh WI 54903
ACORD 25 (2001108)