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ACORDTM CERTIFICATE OF LIABILITY INSURANCE \ DATE (MM/DDNYVY)
06/15/2007
PRODUCER 920-231-5727 920-231-5574 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Monroe Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
15th & Oregon Streets ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 2467 r--' ~-' ,--""'---'~,."'--
Oshkosh, WI 54903-2467 -"-',
~IFc fF" rr"~ n 'I f! :C:; _RS AFFORDING COVERAGE NAIC#
rl'" "~" ;'"' j} \,} 1:,;;"
INSURED , Ok!.2B 2",69'76::,,_...-.--'[ RA:Burns & wilcox Ltd
Oshkosh Youth Soccer Club, I [-- , i INSU ER B:
I '
C/o Terry Toraason \\nl.~:~ i INSUR~R C:
P. O. Box 2621 ;lfilSuRER D:
Oshkosh, WI 54903-2621 ~S'URER E:
COVERAGES I f""'ITV~1 0::,~f!;:~ OFF! .,
THE POLICIES OF INSURANCE LISTED BE~~~.BEE,,*.JSSUED''f'0-l'HEtNSURED 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~f: I~~~ POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
~NERAL LIABILITY EACH OCCURRENCE $ 1,000,000
A X COMMERCIAL GENERAL LIABILITY 3CH6596 05/14/2007 05/14/2008 ~~~~~~J9ta~~?ence\ $
~ U CLAIMS MADE DO OCCUR MED EXP (Anyone person) $ excluded
~ PERSONAL & ADV INJURY $ 1,000,000
~ GENERAL AGGREGATE $ 1,000,000
n'L AGGREn LIMIT APn PER: PRODUCTS - COMP/OP AGG $ included
POLICY ~:;'RT LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
-
- ALL OWNED AUTOS BODILY INJURY
(Per person) $
- SCHEDULED AUTOS
- HIRED AUTOS BODILY INJURY
$
NON-OWNED AUTOS (Per accident)
-
PROPERTY DAMAGE $
(Per accident)
RRAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
OESSIUMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR D CLAIMS MADE AGGREGATE $
$
H DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I T"X~;T ~I,~'c, I IOJ~-
EMPLOYERS' LIABILITY
ANY'PROPRIETORIPARTIiIERIEXECUTIVE E.L. EACH ACCIDENT - $
OFFICER/MEMBER EXCLUDED? EL. DISEASE - EA EMPLOYEE $
If yes, describe under
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
City of Oshkosh and its officers, council members, agents, employees and authorized volunteers are named
insured
CERTIFICATE HOLDER
CANCeLLATION
City Of Oshkosh
215 Church
Oshkosh, WI 54902
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ...1.Q._ 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 R RESENTATIVE
ACORD 25 (2001/08)
CORPORATION 1988