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ACORD~ CERTIFICATE OF LIABILITY INSURANCE OP 10 K1 DATE (MM/DDNYYY)
90SHTRK 03/29/07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Hays Companies of WI HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1200 N. Mayfair Road Suite 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Milwaukee WI 53226 ...
Phone:414-443~0000 Fax:414-259-8448 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Lexington Insurance CO.
INSURER B:
Oshkosh Truck co~oration INSURER C:
2307 Oreion St'3 0 Box 2566 INSURER D:
Oshkosh I 5490 -2566
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 MAYBE 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.
LTR NSR[ TYPE OF INSURANCE POLICY NUMBER PD~,;!~i~~rJ~~E P2!-~_r(~XPIRA T.1gN LIMITS
DATE MM/DDIVY
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
-
A X X COMMERCIAL GENERAL LIABILITY 4560437 04/01/07 04/01/08 ~~~~~~'=. I U '"''''' I "U $ 500,000
PREMISES (Ea occurence)
i CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $
PERSONAL & ADV INJURY $ 1,000,000
-
- GENERAL AGGREGATE $ 5,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000
Xl nPRO- n
X POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $
ANY AUTO (Ea accident)
-
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
>--
HIRED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
=f' ....."'" AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EAACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1,000,000
A ~ OCCUR 0 CLAIMS MADE 0028360 04/01/07 04/01/08 AGGREGATE $ 1,000,000
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND 1_ WI,;::;IAI.UC \ IUEt
TORY LIMITS ER
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
. ANY PROPRIETOR/PARTNER/EXECUTiVE
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
If yes, describe under EL DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
RE: Application - communications conduit being installed under W W. - ~ U ~ ~1 "\
Avenue in two location. at the 370 W Waukau Avenue property owned ~k~ ~
Truck Corporation. city of Oshkosh is included as an additional i s ~e u-1:,,__'k.---'~-- \
only with respects to liability arising out of Oshkosh Truck Corpo at{j 's R 113 2\lIl1\\ ,
operations subject to the policy terms, forms,conditions & exclusi~;\ AP\_~
CERTIFICATE HOLDER CANCELLATION J -,,------ --...........
90SHKOS SHOULD ANY OF THE ABOVE DESCRI E~n:tSe\'<:'i.~ttt5E~ 'rHI:Yx'PiRJlrION
City of Oshkosh DATE THEREOF, THE ISSUING INSURE R 1 1",~,;r&M'A1t.----30'- DAYS WRITTEN
City Clerk-City of Oshkosh ---
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Attn: Angela Joeckler IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
215 Church - P o Box 1130
Oshkosh WI 54903 REPRESENTATIVES.
~.:cJr!;'~
COVERAGES
ACORD 25 (2001/08)
@ ACORD CORPORATION 198f