HomeMy WebLinkAboutCondon Companies/Brockway City Rebah
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MIVI/DDIYYYY)
6f11f2007
PRODUCER (515) 224-2450 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
TNE - Des Moines ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Regency West 1 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
1501 50th Street, Suite 340
West Des Moines, IA 50266 -!NSURERS AFFORDING COVERAGE NAlC#
...,,,, ,,~...3 ,,"""<'i..,..m'~"'"'''-'''''''''''-~'~'"'''
INSURED Condon compan;e,t ft-:; [!~c' -H re, r,;\ ~,"'ffiA ConUnental Weste'" Ins",ance
126 E Jackson Stre . c. ''''.:'' ,,\, lSURER B:
Ripon, WI 54971-13 \,~ , i I~SURER c:
\.,j ;I~SURER D:
Ii JUN 1 4 2007 INSURER E:
COVERAGES ~ ,Ii ,'., ,
THE Po.LlCIES o.F INSURANCE LISTEd BC~~=~:I~~U~~;j'.91;T8E;jN$:J1R$D NAMED ABo.VE Fo.R THE Po.LlCY PERlo.D INDICATED. No.TWITHSTANDING
ANY REQUIREMENT, TERM o.R Co.NDI\n N' '~.b.cr'tlR..()TH.E.RDOCUMENT WITH RESPECT TO. WHICH THIS CERTIFICATE MAY BE ISSUED o.R
MAY PERTAIN, THE INSURANCE AFFo.EJiE~&Y4'H'E"fYor:rcri::"SADESCR(BED HEREIN IS SUBJECT TO. ALL THE TERMS, EXCLUSlo.NS AND Co.NDITlo.NS o.F SUCH
Po.LlCIES. AGGREGATE LIMITS SHo.WN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ~~~~ P~N~~~~~6g;Q~f Pg~lfeY ~'a;~tJ,gN
LTR TYPE OF INSURANCE POLICY NUMBER LIMITS
~NERAL LIABILITY EACH OCCURRENCE $ 1,000,00(
A X X COMMERCIAL GENERAL LIABILITY BOP2573644 7/1/2007 7f1/2008 ~~~~~~I9E~Eo~~r~nce) $ 100,OOc
I CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $ N/,ll
X Incl Policy # BOP2573644 PERSONAL & ADV INJURY $ 1,000,OOC
f--- GENERAL AGGREGATE $ 2,000,00(
n'L AGGREn LIMIT APnS PER: PRODUC1S . COMP/OP AGG $ 2,000,00(
POLICY P,tW.,: LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
A ANY AUTO CWP25701362 7f1/2007 7/1/2008 (Ea accident)
-
~ ALL OWNED AUTOS BODILY INJURY
$
X SCHEDULED AUTOS (Per person)
-
X HIRED AUTOS BODILY INJURY
~ (Per accident) $
~ NON-OWNED AUTOS
X Comp: $5,000 PROPERTY DAMAGE
X Coli: $5,000 (Per accident) $
~GE LIABILITY AUTO ONLY - EA ACCIDENT $ 1,000,060
A X ANY AUTO CWP25701362 7f1/2007 7/1/2008 OTHER THAN EA ACC $ 1,000,000
AUTO ONLY: AGG $ 2,000,000
3ESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 8,000,000
A OCCUR D CLAIMS MADE CU2580189 7/1f2007 7/1/2008 AGGREGATE $ 8,000,otf6
$
~ DEDUCTIBLE $
X RETENTION $ 10,000 $
WORKERS COMPENSATION AND X I WC STATU-I IOTH-
TORY LIMITS ER
A EMPLOYERS' LIABILITY WC2577365 7/1f2007 7/1f2008 500,00(
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 500,00(
If yes, describe under E.L. DISEASE - POLICY LIMIT $ 500,OOC
SPECIAL PROVISIONS below
OTHER
A Equipment Floater CWP25701362 7/1f2007 7/1/2008 Leased Equipment ;1,000,000 (Oed: $1,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Re: Condon Total Comfort - Brockway City Rehab Job, December 2005.
City of Oshkosh is named an Additional Insured with respect to the operation(s) related to the above job in December 2005.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Oshkosh DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3.!L.- DAYS WRITTEN
City Hall
I.......... . PO Box 1130 NOTlCE..eO.THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO.DO.SP.SHALL
Oshkosh, VV154902- IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE -~ ~_..~ p-'4
--. - --- -==- -----'"--
CERTIFICATE HOLDER
CANCELLATION
ACORD 25 (2001/08)
CONDCOM-01
GIKA
@ ACORD CORPORATION 1988