HomeMy WebLinkAboutCabulance Inc 12/06-12/07
ACORD,.
CERTIFICATE OF LIABILITY INSURANCE
OP IDS3 DATE (MM/DDIYYYY)
CABUI-1 01/19/07
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFO~MATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
Burkart-Heisdorf Insurance
www.burkart-heisdorf.com
1807 Erie Avenue
Sheboygan WI 53081
Phone: 920-458-6174 Fax:920-458-1363
INSURED
INSURERS AFFORDING COVERAGE
NAIC#
Cabu1anc~, Inc.
Mr; Don Davie's.'
;2723 Harrison Street
'Oshkosh WI 54901
COV'ERAGE~'" .
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE Po'LICV PE:RI6DINDfCf\TEb~NOfWitHSTANbING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBEISS'UEDOR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDIT'lbNS OF sucH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
Liberty Mutual/Assigned Risk
L TR NSR TYPE OF INSURANCE
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE D OCCUR
POLICY NUMBER
LIMITS
EACH OCCURRENCE $
$
PREMISES (Ea occurence)
MED EXP (Anyone person)
GEN'L AGGREGATE LIMIT APPLIES PER:
~~T LOC
AUTOMOBILE LIABILITY
ANY AUTO AS1341433661016
ALL OWNED AUTOS
X SCHEDULED AUTOS
X HIRED AUTOS
X NON.OWNED AUTOS
$
$
$
PRODUCTS. COMP/OP AGG $
GENERAL AGGREGATE
PERSONAL & ADV INJURY
A
12/26/06
12/26/07
COMBINED SINGLE LIMIT
(Ea accident)
$ 500000
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
, -' .:. ;.. '/ ',~'~., i "_'
PROPERTY DAMAGE
(per accident)
$
DEDUCTIBLE
RETENTION $
AUTO ONLY. EA ACCIDENT
$
EA ACC $
$
$
$
$
$
$
AGG
GARAGE LIABILITY.
OTHER THAN
AUTO ONLY:
EXCESSluMBRELLA LIABiliTY .
OCCUR D CLAIMS MADE
EACH OCCURRENCE
AGGREGATE
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPE.CIAL PROVISIONS below.
OTHER
--...... ,,-...:
$
E. L. DISEASE - EA EMPLOYEE $
E. L. DISEASE - POLICY LIMIT $
;'''^ ',,~:,
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
CER.TIFICATE HOLDER
CANCELLATION
CITYOSH SHOULD ANY OF THE ABOVE DESCRIBED POLiCiES BE CANCELLED BEFORETHEEXPIRATlbN
City of Oshkosh DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL TEN DAYS WRITTEN
City Clerk NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILl.JRETO DO SO SHALL
PO Box 1130 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
215 Church Avenue
Oshkosh WI 54901 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
David Burkart. CPCU
ACORD 25 (2001/08)
@ACORD CORPORATION 1988