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. CERTIFICATE OF LIABILITY INSURANCE DATE (MMfDDJYYYY)
" ACORDm CSR LD I 10/25/07
OSHCE-1
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
McClone Insurance Group-Osh ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
505 North Westfield Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 2743 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Oshkosh WI 54903
Phone: 920-233-4000 Fax: 920-233-2728 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Capitol Indemnity Corporation
INSURER B:
Friends of, Oshkosh Parks, Inc. INSURER C:
Tom Ste&ha~
225 S. as urn St. INSURER D:
,Osh]cosh WI 54904 '" ,', H'"" :
" INSURER E:
~".
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TJ-IEEXPIRATlb~
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 _ 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 "\-"~,_ \)v~L
"" @ ACORD CbRPORA TION 1981
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~
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 DOCUMEONT 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,
L TR NSR
TYPE OF INSURANCE
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE ~ OCCUR
POLICY NUMBER
EACH OCCURRENCE
11/02/08
11/02/07
PREMISES (Ea occurence)
MED EXP (Anyone person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS-COMP~PAGG
A
CP00184831
GEN'L AGGREGATE LIMIT APPLIES PER:
j~8T LOC
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
BoblL Y INJURY
(Pe'r person)
BODILY INJURY
(Per, accident)
,!\-.
PROPERTY DAMAGE
(Peraccident)
ALITO ONLY - EA ACCIDENT $
GARAGE LIABILITY
ANY AUTO
OTHER THAN
AUTO ONLY:
EXCESS/UMBRELLA LIABILITY
OCCUR 0 CLAIMS MADE
EACH OCCURRENCE
AGGREGATE
DEDUCTIBLE
RETENTION
$
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If ye-s, describe under
SPECIAL PROVISIONS below
OTHER
$
E.L. DISEASE - EA EMPLOYEE $
E,L, DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
~hL/)? /) t<.giC
CERTIFICATE HOLDER
CANCELLATION
OSHKOS1
CITY OF OSHKOSH
Parks Department
215 CHURCH AVENUE
P.O. BOX 1.130
OSHKOSH WI 54902-1130
ACORD 25 (2001/08)
~
/O)~(P/()7
(JeJ w I AJAL-
LIMITS
$ 1000000
$ 100000
$ 5000
$ 1000000
$ 2000000
$ 20'00'0'00'
$
$
$
EA ACC $
AGG $
$
$
$
$
$