HomeMy WebLinkAboutWI Youth Soccer 9/1/07-9/1/08
Wisconsin Youth Soccer
Association, Inc.
10201 W. Lincoln Ave, Ste
West Allis WI 53227
t?:'::;:" ("':
~~;';-'-"~ ,~~,
CSR BL DATE (MMfDDNYYYl
WISCO-6 08 14 07
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
A~JE::RIH.E VERAGE AFFORDED BY THE POLICIES BELOW.
.... './ "":;" !
. 'I~~'~J~: ~, ING COVERAGE
~ ~: "
I tkel Insurance Co
NAIC#
38970
ACORDm
CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
Bollinger, Inc.
101 JFK Parkway
Short Hills NJ 07078-5000
phone:800-526-1379 Fax: 973-921-28
INSURED II. "''''
[
CITY
, _-,,,,,,,,,,_,,,~~~~.,,,"-,,'c>..._,",",,,,",,,,
I S E P 1 3s I ii
_!. L INSURER c:
" ......_,__,...._..~_...~._. F~' -.i..--....,_~.~"'_.....-,.,.,,~'...__..,!
1,t>J~,UREg D;..,. .
tN:stlR~"'~". to,
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 WHICHTHIS 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.
LTR NSR[ TYPE OF INSURANCE POLICY NUMBER PD'1,;!~1J~fJ~~E Pgk!fE\~~b~~~N LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
I-- P~E'MISES (E~~~~~r~nce)
A ~ COMMERCIAL GENERAL LIABILITY 8502AH078996 09/01/07 09/01/08 $100,000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5,000
~ Incl Participants PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $ 5,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPfOP AGG $2,000,000
~ nPRO- 'n
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
-
ANY AUTO (Ea accident)
I--
ALL OWNED AUTOS BODILY INJURY
I-- $
SCHEDULED AUTOS (Per person)
I-- 09/01/07 09/01/08
A ~ HIRED AUTOS 8502AH078996 BODILY INJURY
(Per accident) $
A ~ NON-OWNED AUTOS
- PROPERTY DAMAGE $
(Per accident)
=ro' """illY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSfUMBRELLA LIABILITY EACH OCCURRENCE $
tJ OCCUR 0 CLAIMS MADE AGGREGATE $ I
$
H DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I. WC STATU- I IU~R-
TORY LIMITS
EMPLOYERS' LIABILITY E.L EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
If yes, describe under E.L. DISEASE - POLICY LIMIT $.
$PECIALPROVISIONS below. . .' .. .~. .. . . .... ..
OTHER
A Accident Insurance 4102AH079001 09/01/07 09/01/08 Med Max: $250,000
Full Excess Ded: $250/Claim
DESCRIPTION OF OPERATIONS / LOCATIONS f VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT' SPECIAL PROVISIONS
The certificate holder is named as an additional insured under the liability
policy. Coverage is provided under this policy only for sponsored/supervised
activities of the named insured for which a premium has been paid.
Oshkosh united Soccer Club
COVERAGES
CERTIFICATE HOLDER
CANCELLATION
City of Oshkosh
Parks Department
215 Church Avenue
Oshkosh, WI 54901
ACORD 25 (2001/08)
&t:/61/lJ1IV ~ 9-//~'l (!0
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOi
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
REPRESENT A TIVES.
AUTHORIZED REPRE
@ ACORD CORPORATION 198