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11/18/2004 THU 15:08 FAX 920 923 1005 FDL MORTGAGE\KKP INS
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ACORD... CERTIFICATE OF LIABILITY INSURANCE 11-18-04
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PROllUCER . I THIS CERTIFICATE IS ISSUED AS A MATTER ut" INFORMATION
l<ELLER-Krug-POLAKOSKI ONLY AND CONFERS NO RIGHTS UPON THE CERTIIFICATE
HOL.DER. THIS CERTIFICATE POES NOT AMEND. EXTEND OR
PO BOX 749 ALTER THe COVERAGE AFFORDED BY THIS POLICIES BELOW.
FOND DU LAC WI 54936-0749 INSURERS AFFORDING COVERAGE
.. ..
INSURElJ INSURE!f(I>;
CHRIS HANSON INSURER B:
DBA GROUND EFFECI'S OF WISCONSIN, INC. INSUReR. ~
2557 W WAUKAU AVE -OS INSURER 0:
OSHKG>SH WI 54904. INSUReR 10;
COVERAGES
THe POLICIES OF INSURANCE LISTED BElOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THe POI.ICY 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 POL.ICleS DESCRlaeo HEREIN IS SUBJECT TO ALL THE TERMS, EXCI.USIONS AND OONDITIONS Ofl SUCH
POl.ICIES. AGGREGATE liMITS SHOWN MAY HAVIi aliEN REOUCED BY PAID CLAIMS,
't'$~ TVPE 01' INSURANCI!l l'ol..l~Y Nt,lMFieR ,oueY E!l'IlSCiIVI! POLICY eXPIRATION \..IMITS
~NE!AAr.. UABILITY I1:ACIot OCCURRENCE $1~ . nnn .nnn
A X COMMERCIAL GE!NERM. UABII..ITV CLOO26355 2-4-04 2-4...05 FIRE: DAMAGE IAn.. ';>nD 11I0\ S 100. nnn
I CLAIMS MACE 0 OCCUR MI:D ex" 'Any QIl. C.'''''''\ !I: .:: nnn
PERSONA~ & AOIIINJURY ~ nnn -nnn.
OENe'FW. AGGREGATe ~, OOO,OOlf
~'L AQC~ne LIMIT Af'r!t P~R; PROOUCTS . COMP/OP AGe ..-, nnn. nnn
POLICY ~~,9,: LOe:
~TOI.IOIllLI! I..IADILtTY COM!IINElJ SI"GLE I..IMIT $ 1,000,000
A~ Auro (Il. _",lIlnO
-
:x: ALL OWNED. AUTOS . BODILY INJURY $
A SCHii:DIJLEC AUTOS -00P603091 2-4-04 2-4-05 (Pit PII~)
\
- HIRl:D Auroa BOOILY INJURY $
NONo()WN~D AUTOS (Plr aGGldlnl)
-
X ::aMP OED 0 PROPERTY CMlAGI!: $
Y r"nT.T. T"'lFn ?i:'\n (por Ilcellllll\)
:::rAOE LIABILITY AUTO ONLY .I!A ACCIDSNT $
ANY AUTO OTHER THAN EAACC !I:
AUTO ONI..V: AGG S
::JE!$$ LIAIIIUT'l' I1ACH oeeURRENCS s
OCCUR 0 Cl.AIMS MADe AGGREaATe $
$
=i ClEDUCTI!lLE $
REieNTlON $ ~.IJ-~I S
WORKERS COhlPIlNllA'I'ION AND IOI~.
A IiWPL.OYEIW lJAtoun' PENDING 9-15-04 9-15-05 E!.L. eACH ACCltleNT s1nn non
I!!.L. DISSASE .I!A EMPLOY!!! .li1nn /,\nn
E,L. DISEASE! . POLICY LIMIT $500.000
OTHeR
DE!SCRIPTIOH OF OPERATIONS/LOC:ATIONSNEHIC:LE$JEXCL.US10!iS ADDEO BY IiiNDOkSI!MIlNT/5PECIAl. PIl.OVli:IONS
CERTIFICATE HOl-DER I ~I AbolTIONAL INSU!U.r '''.''R.lSR r..eTtE~, CANCELLATION
5HOUl.D ,.NY 01" rill! ADOVIi DEliICRlIl~D pouclES DB cANeE!"Ll!D BEfORE 'l'IlE IlXPlRATION
CITY OF OSHKOSH I PATE TIlEllSO'. THIli IlOllUING It<,sUREIl WIU. I!:NlJEAVOR TO MAIl.. ..JQ... DAYS WM'TEN
215 CHURCH AVE NOTICS TO THE! CEltTlPICATI! HO"Dl!R NAMED '1'0 Till! LEF'l'. aUT fAILURE TO 1)0 SO SHALL
OSHKOSH WI 54901 IMItOSIi wo OBLlGATIOil OR UABIUtY OF ANY KIND UpON THI! INSURER, ITS ,~ENTa OR
REPReSeNTATIVes.
AUTHI;>>tlZIOD REPRESENTA1WE
I DENI$~Y
ACORD 2S.s (7/97)
@ACORDCORPORATION 1988
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