HomeMy WebLinkAboutHigh Ave/Pearl Ave
G9-2S-20~7 ' 02:44PM
FROM-ALPHA TERRA SCIENCE
920-892-2620
T-121
P002/0~1~
AGREEMENT
WHEREAS, the City of Oshkosh has granted to the undersigned the privilege to instan monitoring wells on
City Property in conjunction with an environmental inV'esfigation of the properly at 118 High Avenue on propertl'
belonging to the City or Oshlcosh as follows:
The privilege to install. maiDtlW19D.r! conduc:t tests of aonitoring weUs ill the GraDel Opera
HOllse property at 100 High Avenue and High Avenue Parking Lot 3t 110 pead Avenue,
Oshkosb, Wisconsin
WHEREAS, tha parties to this agreement intend that by acceptance of this privilege the undersigned shall become
primarily responsible for damages to person or property by reason of the granting of tha privilege~
NOW, THEREFORE. inccnsideration of the City of Oshkosh. a Municipal Corporation granting permission to the
underslgned to install monitoring wells on City prol=le:rty as described above. the undersigned agrees that it is
solely responsible for its activities under this agreement. The undersigned hereby releases the City of Oshko!lh
from art debt, claims, demands, damages, aotions and causes of action Whatsoever which may res\llt from the
installation of tne monitoring wells by the undersigned. Fureher. the undersigned agrees to protect and hold the
City of Oshkosh harmless against all actions, claIms and demands of any kind or character whatsoever which may
in any way be caused by the actIvities under this agreement by the undersigned agents or employees. Further, the
undersigned sgrees to indemnity and ref'und to the City all such sums whic:h the City may be obligated cr adjUQged
to pay, inCluding the City's attcrney fees and costs, 01'\ such actions, r::lalms or demands within 30 days after
written request forsuoh Indemnification, Ttls ur1deraigned agrees that thIs para.graph is to be liberally constnJ~;ld in
favor of the City of OshkQsh, In consideration of the privilege granted by the City under this agreement.
This agreement and the privUege cannot be assigned without the Wt'ltteneonsent of tne City of Oshkash. The
privilege Is SUbject to all terms and conditions contained if'! any authorizing resolution adopted by the Cil~ of
Osnkosh Common COlJncil, which is incorporated by reference as iffl.llly reoited w1thin this document By
e:a:eeuting this agreement and by using the privilege, the undersigned agrees to fUlly abide by such terms and
conditlons,including revocation upon wrltten notice for noncompliance with the authorizing resolution and this
agreement.
Dated U1is~ day Of!jit:-. 2007.
GUNOE N CLE ~S
Sy:
/lJ.PH~NCE
And: ~-
e: GaN Gunderson. PresIdent
Name & TItle: Donald W. ~ker. Pre!llid.en1:
STATE OF WISCONSIN )
) 5S.
WINNEBAGO COUNTY )
. . A _.1lI1y came before /TIe this d5 day of Sd , 2001. the eboVE1-na/TIeq · · · · · · ·
..-.A::.J"'~ ~U7d/~ to me known to bathe perso[l9sl~~~~~ the
foregoing flocument on behalf of said GUNDERSON CL.EANERS and acknowledged ~_~e',"".', .:.oQ .".
/) . I If.: 'OTAA \~.':
L.fi-i..^^-.e4... . : .
- . ~
NCltaIY Public, Win~.~ . ~~~n;~n
'.l?."t "() ".' ~~.
My Commission: r" ....,...:\'::1; ~ _
.I, .=tl~ .,-
I . , .. , . . ,
Attaohmont: Exhibit ^ Ro~o\ution 11' 07 22i cnd ott:1ohmontc of Of;hkoth Common Council
Meeting 8/28107.
F1- .J:>onl4W1dcr:~a clcft:lld~IlIlZ~' 1tO"'l!IllC>IIdo~I.4IlDD:l!"" l'IIlC>illS;'dbo;
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AUGUST 28, 2007
07-228
RESOLUTION
(CARRIED 7.0 LOST
LAID OVER
WITHDRAWN
)
PURPOSE:
GRANT EASEMENTS - HIGH AVENUE / MARKET STREET /
PEARL AVENUE
ALPHA TERRA SCIENCE AND GUNDERSON CLEANERS,
PETITIONERS
INITIATED BY:
PLAN COMMISSION RECOMMENDATION: Approved w/conditions,
BE IT RESOLVED by the Common Council of the City of Oshkosh that the City
hereby grants easements to Gunderson Cleaners and Alpha Terra Science for the
installation of monitoring wells by Alpha Terra Science on City property in the High
Avenue / Market Street / Pearl Avenue area, per the attached, with the following
conditions: '
1) The monitoring wells be installed in a manner that is approved by the Dept. of
Public Works with no modifications or changes in construction procedure without
prior approval by the Dept. of Public Works.
2) If no longer needed, the wells be properly abandoned and removed in
accordance with City standards and under the direction of the Dept. of Public
Works.
3) Any problem which may arise as a result of the placement of the wells be the
responsibility of the petitioner, contractors and owner to correct in coordination
with the Dept. of Public Works.
4) All appropriate permits be obtained prior to the start of placement of the wells.
5) The wells be modified or removed immediately upon the request of the City.
6) The facility be part of and documented with Digger's Hotline system.
7) The petitioner and contractors secure and submit to the City Clerk a separate
insurance policy which names the City as an additional insured with a minimum
coverage of $200,000 per person and $500,000 in general aggregate.
8), It is the responsibility of the petitioner to file in a timely manner a new insurance
certificate with the City Clerk upon expiration of an existing certificate. Failure to
do so will result in the revocation of the privilege in street upon 10 days notice.
9) The petitioners and contractors execute hold harmless agreements with the City.
BE IT FURTHER RESOLVED that the proper City officials are hereby authorized
and directed to execute any and all documents necessary for purposes of same.
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DISCLAIMER
. ThiS. map Is neither a legally recorded map nor
"1 a survey and it Is not intended to be used as one.
I This drawing Is a compilation of records, data
and information located In various city, county
and state offices and other sources affecting
II' the area shown and It Is to be used for reference
purposes only. The City of Oshkosh is not reo
sponsible for any inaccuracies herein contained.
Ilf dlscrepencies are found, please contact the
.. City of Oshkosh.
,\ Created by - dff
MONITORING WELL
INSTALLATIONS
~/...~
. , c... ..~,
'.:.. ~ -;'
OJHKOfH
ON THE WJ~TER.
Scale: 111 = 100'
City of Oshkosh
Department of
Community DE~velopment
08/09/07
PI'lOO\JCS
MeCJ.one Xnsuranoe Group
150 Main Stree~, S1:Q 102
P.O. Box 389
Mena~ha wr 54952
Phcne:920-725-3232 Fax:g20-72S-3233
"iwsUj'Eo
09-~-2007 ' 02:44PM
FROM-ALPHA TERRA SCIENCE
T-121 P.003/004 F-917
CSR .nT I OATEtNllllllXll'mv)
SUNDE-1 Q9/25/07
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFO~MATION
ONLY AND CONFERS NO RiGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
920-892-2620
ACORD..
CERTIFICATE OF LIABILITY INSURANCE
GlmA:i@rsan, :l:n.e
Gund.erso~ Cleaners, rne.
AeCQnts, LLC .
GU=de~aon Transpo~a~.on LLC
41 Ma:s.n StreB'!:
Menasha WZ 5G952
COVERAGES
INSURERS AF~_R.P.!NG COVERAG~...a.a.".
11IlSUReRA; cln,,1"nlll:J r~sura~-:e ~1lY
I.~'~~~,~."~.__.___...
INSI.IRER C,
INSI.IRER D:
lNSLJRER G:
NAIC#
lllE POUCII;S OF I!\I&UAANCr:.I.1STi:i1) eeLOW !'i4VJ:. seeN ISSuED TO THli! INSURED NAMED ABOVE I=OR THE POLICV PERIOD INDIt::I'.TEC. NO~STANDING
ANY REOUlREMENT. 'TERM QR CONDITION OF ANY CCN'TRACTCR l-'MR OOCUMlSNT W~ RE:SPEr.T m wl<IlCIoI THI~ r,j;:RTIAr"ATE MAY IlIIi 1~5~IED OR
MAV PERTAIN. THE INSURANce APll'CROED BY THE i>OLlCIES 1:J~t:RleED HeRl:lN IS SUBJECTTC ALL THE Tt:RrJlS, roxCI.USlONS AND ctlNClITIONS OF SUCH
POLlOI!;&' AG6~EI3A'lE UoIIrrG SHCWtl W>.VHAVE 6EEN REDUl:EO BVPAIQ CLAIMS.
I~ ~~r'''' .-- TYPEOFINSVRANCS POUCY'NUMBSR
GENiAAL. UAlillUlY
~X' CP
_~MMERClAl.c;I!!NERALLIAB'L11Y . P0717543
__....1.....,.1 CI.AIMljlM/\oe ~ OCCu~
--- .--
......... -
~.I.At;lilRS~LllIII1"AF'~PER
. 1 POl-lev I I ~~ 1 11.00
LIITOMoelUO L.lIlBll.lI'f
~ AHV AUTO
___ ALl. OWNE~ AlJTOS
.... aC;IolEDlJ~F.O AuTOS
....... MIFlIl:D AUTOS
___ NOllloOWNWAlJTCS
X $100 DEI>
x $500 OED
GARAGe L1A8JLrN
=1 tINy ^u'tO
EXCESSlUMBFlSLLA LIAElIUTY
;] OCCu~ r' 'I OlJllMS rMDE
r--j DEDUCTlSLli!
~ RETeNTION 510000
WORKERS coMpeNSATION AND
EMPLOVERS' LIlIHUT't'
~ ANVPROP~leTO~~ARTNEA~ECUTWE
CFRCERIMEMElER l:i!CWDEO?
If m; dgSCllbo 1,II'l4ar.
SPE.CI41. 1>ROVIElIONIl bebtI
O'nl1ilR
A
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A
.. ..-...----- --.-
DAn;: uwn~ nATlOlMwDlVWr
UW1S
~CHOCClJAAENCE 1II1000000
~~ $500000
.P.~M~.~Il~~F.\l},
MED EXI' (Anyone -..en) S 10000,_._....~......."
~$OI'4~:l:~"INJUf;lV $1ooo0oCI
GEI\IEAAL AGGREC;ATE _~ .L-----_.. . ..
P~C?O.lJ~..:~~~~!~AGG $ 2000QB.fL~
12128106
12/28/07
CAP7710S11
12/~8/06'
12/28/07
COMBINED SINGL.E UMIT
{Ea Ilcci~enQ
s 100000CI
BODILY I~URV
(per person)
:I
BOOJI:"::,IIlLJIJRY
IPare"",CIOrI11
$
CCMPREESNSIVE
COLILIS:J:ON
CPIi'0711S43
1212B/06
12/28/0'7
PROPeKr'I' CAMi\GE
(Pel' lI~~,,"ll
.AlJTO.O"'~V-E'AAC~I~F.:N~ G .._..........___
EAACC 1Il
A(it. :;
llACHOeC:URR!;NC! s 1000DOOO
AGGREGATE $100_Q..OO~UL-
-- $--
... ....... ........-- ~_.-
$
X IT~\flJe.~ I IU~~. ____ ...
E.LEACHACCIt)EIIIT $:1.00000
!::!:-~~;,:~.~!~~ .$lO.O~OO
e.L.,OlSEASr:i.folOl.ICYI.IMIT G 500000
t
f;W8~~te~
WC1910312
12/2B/06
12/2S/07
.
DE5tlRIPTION 01" OPERA710NS II.OCATJl)NS I \lEJlIlCLES I EXCUJSION5 ADDED BY liIIIllORl; ;MalT I SPECIAL PRQlllSICNB
l!he Ci.ty Of OshkOSh, aAcl i.ts off~e:r:1!l1 couneil members, aqents, emplcryees,
anQ a~t;horized vclunteersare included as an additional insured unde~
GeDe%'al Liabi.li. ty as their interest ma;y appear.
CERTIFICATE HOJ.ClER
OSBK002
CANCELLA110N
SHOIJLOAhW 01' TMa AEl~E. DESC~em I'I:lUCIES ~ CAhlOELWiCl s!!:I"OIlEt 'rn~ EXr;,RATIOnI
DATE lilERJ;'CF, TI1Iii ISSLlNG INSURER WLl. i:!NP~VCR 10 MAIL. ~ DAYS lM~N
NOTICE 10 THE CSR.TII'ICATE Hcr..DliiFl ~AME.!l TO THE LliF1'. BUT FAtLU~E TQ = I:lClllHAl-L
IMPOSG 1'10 ClSt..llaA'nOlII O/lIJADILJ'IY OF' ANY 1ClI!Il) UPON TItE If\lSUl'lI;R,. rl1:lllGllNTS Oil
IW'RESENnlI1III'5.
A REF' ENTA
C:it7 of Oshkosh
At:t.n: Off!ee of
P.O. SOx 1130
OshkoSh W% 54902
C1erks
("~
@ACORD CORPORATION 1988
ACORD 2S (2001/D8}
09-~-20G7 . 02:45PM
FROM-ALPHA TERRA SCIENCE
920-992-2620
T-121 P.004/004 F-917
___'I&.'", "'...." I" ."'1""\....... '" . .....--...... . . ...--. "". .-- ALPHT -1 I l~9/18/07
PRODUCER THIS CE;RTIFICAT~ IS ISSUED AS A MATTER OF INFORMATION
Burkart-Heiadcrf r~auranee ONLY AND CONFERS NO RIGHTS UPON THE CERTlFICA'TE
www.burkart-heisdorf.com HOL.DER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
lB07 Erie Avenue AL TE.R THE COVERAGE AFFORDED BY THE POl.ICIES BI5LOW.
Sheboygan W~ 53081
Phone: 920-4SS-6174 Fax:920-458-l363 INSURSRS AFFORDING COVERAGE ~IAIC #
INSURED INSURER AI Cincinnati ~nBurance 10677
INSURER B:
Alpha Terra Science, inc. INSURER c:
DOXl. aecker
1237 South Pilgrim Road INSUJ'l.ER 0;
Plymouth WI 53 73 INSUR!:A. E:
COVERAGES
THE POLICIES OF INSURANCE LISieO IlEI.Ow HAilE; ElEEN ISSUED TO T~IE INSURED NAMED ABOVE FOR THE POLICY PEAIOD INDICATED. NOlWITHSTANDIN(;l
ANY REQIJIREr.ENT, TeRM OR CONDITION OF ANY CONTRACT OR OTHeR OOCUMENT WITH ReSPECT TO WHICl-1 THIS CERTIFICATE MAY Be ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BV THE POLICIEs DESCRIBED ~IEREIN IS SUBJECT TO ALL THe TERMS, eXCI.USIONS AND CONDITIONS OF suCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAve seeN ~eDuceD BY PAID CLAIMS.
~TR lISRC TYPE OF INSUlUNCE POLICY NUMBER rDAlE }MMlggrY\il- CATE! IMMlCDrn'1" LIMITS
~ERAL LIABIUTY EACH OCCURRENCE $ 11)00000
A X COMMERCIAL GENERAL LIABILITY CPP091S019 OJ./29/07 01/29/06 ~~~1S~s (~~~~~~ncal $ 5l)00OO
I CLAIMS MADE [i] OCCUR toileo EXP (Any rml:l psr.son) $ ll)OOO
I>ERSONAL & ADV INJURY $.1000000
GENERA~AGGREGATe $ .21)QOOOO
GEN'LAGGREGATE L1M1i APPLIes peR; PRODUCTS. COMP/OP AGG $ 21)00000
Xl POLICY n ~rgT .r=r LOC En\p Ben. 11)00000
AUTOMOBII.E I.IAIilIUTY COM8lN5D SINGLE LIMIT $ ll)OOOOO
-
A ANY AUTO CPA091S0l9 01/29/07 01/29/08 (E:B accident)
-
ALL OWNED AUTOS BODILY INJuRY
- $
..!.. SCHEDULED AUTOS 'Per pCl$gn}
1S.. HIRED AUTOS BODILY INJuRY
III
1S.. NON..QWNEC AUTOS (Par accident)
- PROPERlY DAMAGE 51
(Per aecldenl)
~RAGE UABII.ITY AUTO ONLY - Ell ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG 51
EXCeSSIUMaRIOLLA LIABILITY EACH OCCu~~NCE 51
::J OCCUR 0 CLAIMS MAPE AGGREGATE $
$
=1 oeoLJCTlElLE $
RE'!'E:NTION $ $
WO~KERS COMPeNSATION AND ITORY LIMITS I IU~~-
A EMPI.OYERS' UABILlTY WC191887202 01/29/07 01/29/08 E.L EACH AcCIDENT $ 500000
ANY PROPRIETORJPARTNERle:xgCVTIVE
OFFICERlMEMeER exCLUOeD? E.L DISEASE - EA EMPLOYEE $ SOOOOO
gp~~,if~~v'J~f~~ calew ~.L DISEASE - POLICY LIMiT $ SOOOOO
OTHER ~\
A property S@cticn CPP0918019 01/29/07 01/29/08
A EQUi~ment Floate CPP091BOl9 01/29/07 01./29/08
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICUOS I EXCLUSIONS ADDED BY ENT;IORSl;MeNT I SPECIAL PROVISIONS
City of Oshkosh is recognized as an additional insured for general liability
in regards tc work performed by Alpha Terra Science inc.
CERTIFICATE HOL.DER
City of oshkosh
Attn: Lynn Lorenson
P.O. Box 1130
215 Church Avenue
Oshkosh Wi 54902-1130
CANCEL.LA nON
OSHK _ 02 SHOULD ANY OF THE ABOVE DESCRIB~ POI.ICIES Ill< CANCELLED BEFOI~E lliE EXPIRA TIOH
DATE 1I1EReOF, THE ISSUING INSURER WII.L l;NDEAVOR TO MAD.. TIllN _ DAYS WRITTliiN
NOTICE TO THE CERTIFICATE HOLDER NAMW TO THE LEFT, BUT FAILURE: TO DO 50 5t1ALI.
IMPOSE NO OBI.IGA TlON OR LIABILITY OF ANY KIND UPON THE! INSURER, ITS AGENTS OR
REPRE5EiNTATlVI!S.
AUlliOftJlEtI ~EPReSE~TAllVE
Andrew G. Burkar~, CPCU, RHO
@ACORDCORPORATION1988
ACOR.D 25 (2001/08)
Cd, ;, 2~~i 2: LLFV
('j-f:;; Ci~
\ 1 t"o ,'", I.' - -;F' ~
\ ~I. ::: IJ v . '"
AGREEMENT
WHEREAS. the City of Oshkoth has. granted to the undersigned a prMlege to place an obstruction
as folto\Ys:
ToinstaU monitorfng wells in the Grand Opera t10use property st 100 HigI1 Avenue and High AVE!nue
Parking Lot at 110 Pean A\lfmUe. Oshkosh. Wl8cQnsin.
Wl-EREA$, Slate law provides that by Its acceptance of this privijege the lmder$!gned shan become
primarily reaponsibre for damages to person or property by re;astln of the granting of the prMlege;
NOW. THl:~eFORE, .In consideration of the City of Oshkosh, a Municipal COlPoratfon granting
permission to the und$1'8Jgned tolnetall m(Jf1itOMg !Neils as aboveode~fbed, the undersigned agrfl&s that
It fs. soJeIy responsible forib at;:tivities UJ'lderttlis agreement The undersigned hereby releases the City of
O$hkc$h from all debt. ClGlt1l8, demands, damag'e$, i!lCtlons and CElUSes or actrQnwhatsoeverWh~ mayreslAt
. from the installation of said' monitoring woUs by the undersigned. . Further, the undersigned agrees lO protect
and holdths City of Oshkostll1armJess egainst all actions, cralms and demands of any kind Qr charac;ter
w~ \\t1ic1l may in any way be C8IJSGd by the: ~tivities under this privilege by the Undersiglled or agents
or employees. Furth&r, the undersigned agreos tp i1dermiy l:i.od re:fund to the City all Sl.JCh sums which the
CAy may be obligatedcr adjudged to pay. incI~ toe City'$ _may fees and costs, on $ud1 actions. cl8fms
or demandS Within 30 days after writ,ten request for sud! i'!demnificatton. The undersigned agrelii$ that this
paragraPh it to. be liberally r;:onstroed in favor of the CIty of Oshkosh, in COh$fderatittt of the privijega granted
by ttle City underthil agreement
ThM~t and 1he privilege cannot.be assigr'Jetiwithout the Mitten. con~ of the Cllyof OSJ'tkosh.. The
priYDege IS subject to all tetms andconditiol1$ Contained rn any authoriZing resolution adopted by the cay of
~kosh Common CfMlcl, whloh Is lnOOl'POla1edby reference as if fuMy recited Wlthill thJs doCUment. By
exeQUti1g fhis agreement end by u$ing the privilliJQ8; hi. tn1erslgned agrees to fuly abJdeby such terms an(f
eonditfons. indud.l1g I'f!V<Qtton llpon Wl'ilten notfoe for t'JOncomPliance with.tl'le ~orizing resolution and this
agreement
Dated th18. q~ day of . Cbc.t.. ~ ,2007,
~~~c.
And:
STATE OF' WISCONSIN )
) $S.
SHEBOYG~N COUNlY)
Perso~y came. befor~ me this 9TH day of OCTOBER. .' 2001, the ~"amed
MICHAEL P. MCARDLE .. '.. ..... .. .. oftheebove-namedJXlfponttiOD"
to me known to be the person(5) and offlCel'($) who executed the fQfegoJng document and acknt)wr,a~ lhev"'~~. '.
same as SUCh afflcer~ by Its au1horrty, for the purpose therein comeined.<>....... >), :'"
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AUaehment:
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Exhibit A.... Re$OIutionff.01-228 and attachtneAt$of Oshkosh CommonCOuned"'i' 1"""":'.":
Meeting 8128101.' ';;;;" " . .....,. .. .. . .
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AUGUST 28, 2007
07 -228
RESOLUTION
(CARRIED 7. V LOST
WITHDRAWN
)
LAID OVER
PURPOSE:
GRANT EASEMENTS - HIGH AVENUE / MARKET STREET /
PEARL AVENUE
ALPHA TERRA SCIENCE AND GUNDERSON CLEANERS,
PETITIONERS
INITIATED BY:
PLAN COMMISSION RECOMMENDATION: Approved w/conditions.
BE IT RESOLVED by the Common Council of the City of Oshkosh that the City
hereby grants easements to Gunderson Cleaners and Alpha Terra Science for the
installation of monitoring wells by Alpha Terra Science on City property in the High
Avenue / Market Street / Pearl Avenue area, per the attached, with the following
conditions:
1) The monitoring wells be installed in a manner that is approved by the Dept. of
Public Works with no modifications or changes in construction procedure without
prior approval by the Dept. of Public Works.
2) If no longer needed, the wells be properly abandoned and removed in
accordance with City standards and under the direction of the Dept. of Public
Works.
3) Any problem which may arise as a result of the placement of the wells be the
responsibility of the petitioner, contractors and owner to correct in coordination
with the Dept. of Public Works.
4) All appropriate permits be obtained prior to the start of placement of the wells.
5) The wells be modified or removed immediately upon the request of the City.
6) The facility be part of and documented with Digger's Hotline system.
7) The petitioner and contractors secure and submit to the City Clerk a separate
insurance policy which names the City as an additional insured with a minimum
coverage of $200,000 per person and $500,000 in general aggregate.
8). It is the responsibility of the petitioner to file in a timely manner a new insurance
certificat'e with the City Clerk upon expiration of an existing certificate. Failure to
do so will result in the revocation of the privilege in street upon 10 days notice.
9) The petitioners and contractors execute hold harmless agreements with the City.
BE IT FURTHER RESOLVED that the proper City officials are hereby authorized
and directed to execute any and all documents necessary for purposes of same.
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131.84'
79.7'
<07
DISCLAIMER
I This map Is neither a legally recorded map nor
! a survey and It Is not intended to be used as one.
I This drawing Is a compilation of records, data
and information located in various city, county
and state offices and other sources affecting
IJI' the area shown and It Is to be used for reference
purposes only. The City of Oshkosh Is not reo
. sponsible for any Inaccuracies herein contained.
.1 If dlscrepencies are found, please contact the
City of Oshkosh.
Ii Created by - dff
MONITORING WELL
INSTALLATIONS
OJHKOfH
ON THE WATER
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Scale: 1" = 1 00'
City of Oshk.osh
Department of
Community Development
08/09/07
TREMPE INSURANCE AGENCY, INC
1452 N 43RD STREET
SHEBOYGAN, WI 53081
DATE (MM/DDIYY)
9/28/2007
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CI:RTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLlCIE:S BELOW.
COMPANIES AFFORDING COVERAGE
INSURED
COMPANY
A
ACUITY
M & K ENVIRONMENTAL & SOILS DRILLING LLC
PO BOX 216
GLENBEULAH, WI 53023
COMPANY
B
COLONY
COMPANY
C
THIS IS TO CERTIFY THAT 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 B Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE (MM/DDIYY) DATE (MM/DDiYY)
GENERAL LIABILITY 003746 2-12-07 2-12-08 GENERAL AGGREGATE $ 1,000,000
A ~"'RC"' G'""'''''"m PRODUCTS-COM~OPAGG $ 1,000,000
CLAIMS MADE 0 OCCUR PERSONAL & ADV INJURY $ 1,000,000
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE (Anyone fire) $ 100,000
MED EXP (Anyone person) $ 1,000
~UTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
A ANY AUTO
ALL OWNED AUTOS BODilY INJURY , $
X SCHEDULED AUTOS 003746 2-12-07 2-12-08 (Per person)
I HIRED AUTOS BODilY INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT i$
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRElLA FORM $
OTH.
WORKER'S COMPENSATION AND 0003746 2-12-07 2-12-08 ER
A EMPLOYERS' LIABILITY El EACH ACCIDENT $ 100,000
THE PROPRIETOR! I)(! INCl I El DISEASE - POLICY LIMIT $ 500,000_
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCl. El DISEASE - EA EMPLOYEE $ 100,000
OTHER EACH CLAIM $1,000,000
B POLLUTION LIABILITY CP203691 3-17-007 3-17-08
AGGREGATE LIMIT $1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
THE CITY OF OSHKOSH, AND ITS OFFICERS, COUNCIL MEMBERS, AGENTS, EMPLOYEES AND AUTHORIZED VOLUNTEERS SHALL
BE ADDITIONAL INSUREDS
CITY OF OSHKOSH
PO BOX 1130
OSHKOSH, WI 54920
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESEN'TATIVES.
AUTHORIZED REPRESENTATIVE
LESLIE R. TREMPE