HomeMy WebLinkAboutBrews N Blues/07
ACORDN CERTIFICATE OF LIABILITY INSURANCE . OP 10 2~ DATE (MM/DDIYYYY)
WISC-22 06/04/07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Johnson Insurance - Green Bay HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
812 Cormier Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Green Bay WI 54307
Phone: 920-499-4000 Fax:262-619-2805 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: National Specialty Insurance
INSURER B:
Wisconsin Jaycees, Inc. INSURER C:
Steve Moddie
P. O. Box 1547 INSURER 0:
Appleton WI 54913-1547 INSURER E:
CANCELLATION
C ITYO SH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA TIOI
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ 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.
AUTH PRESE TATIVE
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.
PREMISES (Ea occurence)
MED EXP (Anyone person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
POLICY NUMBER
TYPE OF INSURANCE
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE ~ OCCUR
EACH OCCURRENCE
01/01/08
01/01/07
NSS0451754
A
X Special Events
GEN'L AGGREGATE LIMIT APPLIES PER:
~r8T LOC
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Per accident)
AUTO ONLY - EA ACCIDENT
GARAGE LIABILITY
ANY AUTO
OTHER THAN
AUTO ONLY:
EXCESS/UMBRELLA LIABILITY
OCCUR 0 CLAIMS MADE
EACH OCCURRENCE
AGGREGATE
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
t~flt~2fJ~~13~W~~~m'6WMECUTIVE
If yes, describe under
SPECIAL PROVISIONS below
OTHER
$
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Oshkosh Jaycees - Brews N Blues - Policy Includes $1 Million Liquor
Liability. Policy Excludes: Fireworks, Race & Sport Participants, Mechanical
& Thrill Rides.
CERTIFICATE HOLDER
City of Oshkosh
Parks Dept
City Hall, Room 106
PO Box 1130
Oshkosh WI 54901
ACORD 25 (2001/08)
LIMITS
$ 1000000
$ 100000
$ Excluded
$ 1000000
$ 2000000
$ 2000000
$
$
$
$
$
EA ACC $
$
$
$
$
$
$
AGG
'.-,0,;:
@ ACORD CORPORATION 198