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ACORQM CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY)
03/30/2007
PRODUCER (920)330-9000 FAX (920) 330-9001 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
'Bayl and Insurance Group, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
3138 Market Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
'0 Box 28136
Green Bay, WI 54324-0136 INSURERS AFFORDING COVERAGE NAIC#
INSURED Midwest Sports Events INSURER A: Capitol Indemnity Corp.
2079 Lawrence Dr Ste D INSURER B: Middlesex Ins
DePere, WI 54115 INSURER c:
INSURER D:
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 \I\IITH 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
POLlCIES~ AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
1!'I~.ll- ~!m:l TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
GENERAL LIABILITY CP00318379 01/23/2007 01/23/2008 EACH OCCURRENCE
rx- COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
1--1 CLAIMS MADE 00 OCCUR
(
COVERAGES
A
x
LIMITS
$
$
$
$
$
$
MED EXP (Anyone person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMPIOP AGG
GEN'L AGGREGATE LIMIT APPLIES PER:
---, n PRO. n
I POLICY JECT LOC
AUTOMOBILE LIABILITY
-
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
r=!, ~. :--. r~i ""[' '~o8~1~3u~~:;: l:~\ -, $
: I r . \ b!::;,,,, ,(~~r:~e,rn.~?~,_~. .' ..... ' ~
Ii' \........-. r~~~~~~~~RY Ii; !; I $
!. I APR J ~._"-\;JUl ;~:I ;
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~!TY CLEF~~~.TOP~~;:E4ASCIl:i~NT: $
-QTHER'Tl'lAW-_".EAACC, $
AUTO ONLY: AGG $
$
$
$
$
$
-
-
-
-
-
-
~RAGE LIABILITY
I ANY AUTO
EXCESSlUMBRELLA LIABILITY
:J OCCUR 0 CLAIMS MADE
~ DEDUCTIBLE
...-1 RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
B ~~~I~~~:~1~~~~m~~ECUTIVE
If yes, describe under
SPECIAL PROVISIONS below
OTHER
EACH OCCURRENCE
AGGREGATE
89-33094-01 01/26/2007
01/26/2008 X I we STATU. I I OJ~-
E.L. EACH ACCIDENT $
E.L. DISEASE. EA EMPLOYEE $
EL DISEASE. POLICY LIMIT $
~jOtSCRlPTl.QNO.OFhokPERAhnONS&l LQCtATlONSflfVjOHICLES' EXCLUSION~lADDEDmbBY ENDORSEMENTt' SPECIAL PR10VISIONS & authorl' z. ed vol unteers
1 y ot S OS I 1 S 0 lCerS, COUnCl me ers, agen s, emp oyees,
~hall be Additional Insureds.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
..2L DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGA nON OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
I
Ci ty of Oshkosh
215 Church Avenue
Oshkosh, WI 54901
Jodi Tousev/CINDY
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@ACORDCORPORATION 1988
ACORD 25 (2001/08)
1,000,000
50,000
5,000
1,000,000
2,000,000
1,000,00
$
100,000
100,000
500,000