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ACORD~ CERTIFICATE OF LIABILITY INSURANCE OP ID 2~ DATE (MM/DDIYYYYj-
WISC-22 03/02/07
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
'F"- ....ne: 920-499-4000 Fax:262-619-2805 INSURERS AFFORDING COVERAGE NAIC#
I ::0 INSURER A: Na tional Special ty Insurance
INSURER B:
Wisconsin Jaycees, Inc. INSURER C:
steve Moddie
P. O. Box 1547 INSURER 0:
Appleton WI 54913-1547 INSURER E:
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 SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID C;LAIMS.
NSRi POLICY NUMBER POL1SiY E~f_EE~E PPPCY ~~f.!~T~N LIMITS
LTR TYPE OF INSURANCE DATElMM/DDIYY OA TE" (MM/DDIYY
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
- I PREMISES (E~~~~~nce)
A X COMMERCIAL GENERAL LIABILITY NSS0451754 01/01/07 01/01/08 $ 100000
! CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ Excl tided
PERSONAL & ADV INJURY $1000000
-
~ Special Events GENERAL AGGREGATE $ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER: ,.".,....,......-..~..'". .. .--~'. PRODUCTS - COMP/OP AGG $2000000
h nPRO- n ) ["';", :.7' , ,
POLICY JECT LOC -':".
AUTOMOBILE LIABILITY ii' '. .< . .
I-- ....-.,..-'.. COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
f-- i
ALL OWNED AUTOS , MAR o 6 ZOOl BODILY INJURY
- . $
~ (Per person)
- SCHEDULED AUTOS t.
HIRED AUTOS :' '~--y '-. ..-.
i """ BODILY INJURY
- $
NON-OWNED AUTOS (:; fr" :i~ ' <-. ...: (Per accident)
-
-- ...-,. _d - . .. .. PROPERTY DAMAGE
- $
(Per accident)
-
) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $ . -.
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
tJ OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND ITOR'v"LIMITS I jVER-
EMPLOYERS' LIABILITY
ANY P'ROPRIETORlPARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
If yes, describe under E.L. DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
'"
.'
SCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
shkosh Jaycees - Easter Egg Hunt - Policy Excludes: Fireworks, Race &
?ort Participants, Mechanical & Thrill Rides, and Liquor Liability
RTIFICA TE HOLDER
CANCELLA TION
CITYOSH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
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.
AUTHORIZED REPRESENTATIVE
Brian L. Plamann
City of Oshkosh
- --- T PO Box 1130
Oshkosh WI 54903
)RD 25 (2001/08)
@ ACORD CORPORATION 1988