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ACORDw CERTIFICATE OF LIABILITY INSURANCE OP ID r:~. DATE (MMlDDIYYYY)
BLUEMEL 10/03/05
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
The Starr Group HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
POBox 20001 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Greenfield WI 53220-0001
Phone: 414-421-3800 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Frankenmuth Mutual Ins Co 013986
INSURER B: ..
BluemelsFloral/Garden Ctr Inc INSURER c:
Bluemels Maintenance Service
4930 West Loomis Road INSURER D:
Greenfield WI 53220
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.
I~~~ 1A:S~i: TYPE OF INSURANCE POLICY NUMBER PD~1!~1ri~rrf&~!XE P8k!fEYI~rXb'1fJ!gN LIMITS
GENERAL LIABILITY
>--
A X COMMERCIAL GENERAL LIABILITY CPP3 039530
. \ CLAIMS MADE [!] OCCUR
HIRED AUTOS
EACH OCCURRENCE $ 1000000
10/01/05 10/01/06 p~~~s (ta~~~~~nce) $ 200000
MED EXP (Anyone person) $ 10000
PERSONAL & ADV INJURY $ 1000000
GENERAL AGGREGATE $ 2000000
PRODUCTS - COMP/OP AGG $ 2000000
EmP Ben. 1000000
COMBINED SINGLE LIMIT $ 100()OOO
10/01/05 10/01/06 (Ea accident)
BODILY INJURY $
(Per person)
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $
(Per accident)
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC $
AUTO ONLY: AGG $
EACH OCCURRENCE $ 3000000
10/01/05 10/01/06 AGGREGATE $ 3000000
$
$
$
ITB'~l~I~:~s I IOJ~-
-
X VOL PD 2500/2500
GEN'L AGGRE~E LIMIT AP~S PER:
il POLICY I I ~~~T I I LOC
AUTOMOBILE LIABILITY
f---
A ~ ANY AUTO BA3039530
ALL OWNED AUTOS
>--
f--- SC!:lE[)ULEDAUTOS
>--
NON-OWNED AUTOS
f---
>--
GARAGE LIABILITY
==1 ANY AUTO
EXCESs/UMBRELLA LIABILITY
A i!J OCCUR D CLAIMS MADE CPP3039530
10/01/06 E.L. EACH ACCIDENf $ 100000
E.L. DISEASE - EA EMPLOYEE $ 100000
E.L. DISEASE - POLICY lIMJJ...~ -5. 00000
~f~~'\
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIO~\ \ '\ \ ;:..-- \ I '. ~J\
project: Playground Equipment ~. ( G.l~~t). \\." .~.
\ ()\J a ~;;:E.
~~?~S ~.
\' crr< C~ __
~
h DEDUCTIBLE
Tx RETENTION $
WORKERS COMPENSATION AND
A EMPLOYERS' LIABII"lTY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
OTHER
we 3039530
loi01i05
A
Equipment Floater
CERTIFICATE HOLDER
CANCELLATION
CITY OF OSHKOSH
215 CHURCH AVENUE
OSHKOSH WI 54903
CIOS215 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE: CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 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 REPRESENTATIVE
Timothv F Starr, CIC
@ACORD CORPORATION 1988
ACORD 25 (2001/08)
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