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PRODUCER
MAGUIRE INSURANCE AGENCY
250 N. SUNNYSLOPE ROAD, STE 130
BROOKFIELD, WI 53005
262-796-0760
DATE: (MM/DD/VYVY}
06/11/2007
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
_..ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
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ACORDTM
CERTIFICATE OF LIABILITY INSURANCE
INSURED
ALZHEIMER'S ASSOCIATION OF
GREATER WISCONSIN, INC
2900 CURRY LANE, SUITE A
GREEN BAY, WI 54311
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COVERAGES
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INSU~ERS AF;FpRDING COVERAGE
INSU-RERA:: pHlt:ADELPHIA INDEMNITY INSURANCE
SURER B' !I:'IBER.TY MUTUAL INSURANCE
"-~ "., ~
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED-NAIVlED'As'OVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT O~ 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.
IN5R ~~~~ TVp C" POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR
~ERAL LIABILITY EACH OCCURRENCE $ 1,000,000
A X COMMERCIAL GENERAL LIABILITY PHPK234948 07/01/2007 07/01/2008 ~~~~~~s Ea occurence) $ 100,000
I CLAIMS MADE [lS] OCCUR MED EXP (Anyone person) $ 5,000
1S... PROFESSIONAL L1AB I PERSONAL&ADVINJURY $ . 1,000,000
X EMPLOYEE BENEFITS GENERAL AGGREGATE $ 2,000,000
-'-'-
~'LAGGREnE LIMIT AP~ PER: PRODUCTS, COM PlOP AGG $ 2,000,000
POLICY ~~,9.: X LOC
A ~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
ANY AUTO PHPK234948 07/01/2007 07/01/2008 (Ea accident}
-
- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person}
-
L HIRED AUTOS BODILY INJURY
$
L NON,OWNED AUTOS (Per accident)
- PROPERTY DAMAGE $
(Per accident}
I AUTO ONLY, EA ACCIDENT ,
{ RRAGE LIABILITY $ I
{ EA ACC $
ANY AUTO OTHER THAN
AUTO ONLY: AGG $
0ESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 2,000,000
A X OCCUR D CLAIMS MADE PHUB085498 07/01/2007 07/01/2008 AGGREGATE $ 2,000,000
$
~ DEDUCTIBLE 1$
X RETENTION $10,000 $
WORKERS COMPENSATION AND I WCSTATU, I 10TH'
WC1-34S-3454 72-0107 07/01/2007 07101/2008 TORY LIMITS ER
B EMPLOYERS' LIABILITY E.L EACH ACCIDENT $ 100,000
ANY PROPRIETOR/PARTNER/EXECUTIVE I
OFFICERIMEMBER EXCLUDED? E.L. DISEASE, EA EMPLOYEE $ 100,000
If yes, describe under E.L DISEASE, POLICY LIMIT $ 500,000
SPECIAL PROVISIONS below
OTHER I
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
REGARDING THE MEMORY WALK TO BE HELD 9/15/2007 OSHKOSH
CERTIFICATE HOLDER
CANCELLA TION
TRISH WENDORF
CITY OF OSHKOSH
CITY HALL - PARKS DEPARTMENT
215 CHURCH AVENUE
POBOX 1130
L- I OSHKOSH, WI 54902-1130
ACORD 25 (2001108) Ii /J A ,J/ /, / f
{f)t[(PI/lJftL-~ (tJ/!d-j07
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORI; 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
ION OR LIABILITY OF AN IND UPON THE INSURER, ITS AGENTS OR