HomeMy WebLinkAboutARC Winnebago County Disability Asso
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ACORD,M CERTIFICATE Bi ~ K'6 ~~Itr' '8 ANCE DATE (MM/DD/YYYY)
3/113/2007
PRODUCER (920)235-3450 FAX: (920) .,., 731 THIS t;:F I ICATE IS ISSUED AS A MATTER OF INFORMATION
FirstChoice Agency W'u ONL'I ~, CONFERS NO RIGHTS UPON THE CEIHIFICA TE
Insurance MAR 2 0 2 )O~OL[ ~ IS CERTIFICATE DOES NOT AMEND, EXTEND OR
338 Pearl Ave LTE COVERAGE AFFORDED BY THE POLICIES BROW.
P.O. Box 766 ..1
,.,
Oshkosh " '( . ." WI 54903 0 10(0:1 I v ~1 I=RK'~ ._....-~ FORDING COVERAGE NAIC#
INSURED . - ~€Xn6~nnati Ins. Co. CL
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ARC- Wiririebago County Disability Association, INSURER B: ....
36 Broad St, Ste 310 INSURER C:
INSURER D:
Oshkosh WI 54901-5259 INSURER E:
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.
INSR ADD'L POLICY NUMBER P~1-+~~~~~6g~~ Pgk~:(~~~~N LIMITS
TYPE OF INSURANCE
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
- ~~~b~H?E~~~JcTr~ence!
X COMMERCIAL GENERAL LIABILITY $ 100,000
A I CLAIMS MADE ~ OCCUR CPP0820292 2/14/2007 2/14/2008 MED EXP (Anv one person! $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
Xl nPRO- n
X POLICY JEr.T LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
- (Ea accident) $
ANY AUTO
- 2/14/2007 2/14/2008
A ALL OWNED AUTOS CPP0820292 BODILY INJURY
- (Per person) $
- SCHEDULED AUTOS
X HIRED AUTOS ( BODILY INJURY
- (Per accident) $
~ NON-OWNED AUTOS ...
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY FA!:H $
[] OCCUR D CLAIMS MADE AGGREGATE $
$
q DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I T'X~$T~m;, I OJ~-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
The City of Oshkosh and its Elected or Appointed Officials is/are an Additional Insured on the General Liability
policy, per policy forms & conditions.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CITY OF OSHKOSH EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
215 CHURCH AVE 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
PO BOX 1130 -
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIIND UPON THE
OSHKOSH, WI 54903-1130
INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Rachel Cleven CIC
ACORD 25 (2001/08)
INS025 (0108).08 AMS
@ ACORD CORPORATION 1988
(:':1 ™ Wolters Kluwer Financial Services
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