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Home My WebLink About31119 / 81-14�. Januaxy 8. 1981 # 1�1 F�Spi�UPI�I -r •� • er•��a i�r � , �c • e� �� i � • • ,�•,ra� � m � • � r 1��/4M 3 Y� L MffY SlutA� ^yY: t Y��. BE IT R�OLVED �y thr> C��nr. Ccunci.l of the Ci±y of Qsh_kosh. *?��t th� pmper City officials aze hereby authorized and directeci ta ezater intr� the appropriate agzeement for e�xqency anbulance s�nri.ce between Winnebago County and i-he City o£ Oshkosh. - L4 - �,�B:�7IT':kD :t�F APc^fl�V?JD ��1'l/ EMERGENCY AMQULANCE SERVICE AGREEMENT BETWEEN WINNEBAGO COUNTY AND THE CITY OF OSHKOSH THIS AGREEMENT is made and entered into this 21st day of January , �g 81 , by and between 4Jinnebago County, a State of !�isconsin tlunicioal Corporation, by its County Executive and County Clerk, hereinafter called "COUNTY", and CITY OF OSHKOSH, a State of Wisconsin Municipal Corporation, by its proper officers WITNESSETH: hereinafter called "PROVIDER". For and in consideration of the mutual agreements herein contained and other good and valuable consideration, the County and Provider do agree as follows: 1. DESCRIPTION, TYPE AND MANNER OF SERVICE TO BE PERFORMED: Provider agrees to arovide emergency ambulance service as herein- after defined in that portion of Winnebago County, Wisconsin, as identified on EXHIBIT "A" attached hereto and made a part hereof. The area to be served by Provider may be amended by mutual agreement of the parties. Provider agrees to give the County at least thirty (30) days advance written notice of a request for amendment of area to be served. For purposes of this agreement, emergency ambulance service shall be defined as that ambulance service which is necessary to respond to a condition that in the opinion of the oerson, his family or whoever calls for and/or attends the person, requires irtmediate medical attention and specifically excludes non-emergency transfer calls. 2. TERM: The term of this agreement shall be from January 1, 1981, through December 31, 1981, unless terminated sooner pursuant to other provisions of this agreement. e —� J 3. EQUIPMENT AND STRFFING OF AMBULANCES: Provider agrees to have available on a 24-hour basis at least TWO (2 ) fully equipped and staffed ambulance(s) for use in the area to be served by Provider. Provider further agrees that the provisions of sec. 146.50, Stats., shall prevail insofar as equipping and staffing ambulances used by Provider to satisfy the requirements of this agreement. 4. INSURAP�CE: Provider agrees to carry not less than the followina types and amounts of insurance: Comnrehensive Vehicle Liability Insurance .....................$250,000/$1,000,000 (bodily injury) $ 50,000/$ 100,000 (prooerty damage) Uninsured Ptotorists .....................$ 15,000/$ 30,000 Workers' Compensation ...................Statutory limits or Self-Insured Professional Liability ..................$250,000/$ 500,000 Provider further agrees to furnish a certificate of insurance in force with a ten (10) day notice of cancellation to the Winnebago County Insurance Administrator, c/o Courthouse, Oshkosh, Wisconsin, 54903. 5. HOLD HARMLESS CLAUSE: Provider will indemnify and hold the County harmless from all liabilities, judgments, costs, damages and expenses which may accrue against, be charged to, or recovered from the County by reason of or on account of damage to the prooerty of, injury to, or death of any person arising from Provider's performance of its duties under this agreement. 6. EXPENDABLE SUPPLIES: Supplies for emeroency use as hereinafter defined shall be furnished by Provider as necessary, Provider may establish a reasonable charge to the ambulance user for providing said expendable supplies. Provider -2- � agrees that any charge established hereunder shall be uniform throughout the area served by Provider pursuant to this agreement. For purposes of this agreement, supplies for emergency use shall be defined as those medical supplies which are essential for the personnel who are staffing ambulances used by Provider to orovide adequate care for the critically ill and injured at the emergency scene and during transport to medical facilities, including but not limited to the following: (a) Oxygen (b) Disposable blankets (c? Universal dressings (d) Sterile gauze pads (e) Soft roller-type bandages (f) Adhesive tape (g) Splints (h) Boards In addition, Provider may charge the ambulance user an amount not to exceed Fifteen and �0/100 Dollars ($15.00) for each of the follnwing services if prescribed 6y a ohysician: (a) Intravenous (b) Drugs (c) Heart monitoring 7. MILEAGE: Provider may establish a charge to the ambulance user to cover mile- age costs. Provider agrees that the mileage rate established for emergency service rendered by Provider outside Provider's municipal boundaries shall not exceed Tvio Dollars and Fifty Cents ($2.50) per mile for the distance from the emergency scene to the medical facility to which the ambulance user is transoorted. 8. PAYMENT BY COUNTY: For the emergency ambulance services rendered by Provider hereunder, the County agrees to pay Provider the annual sum of SEVENTY-SEVEN THOUSAND TWO HUNDRED THREE DOLLARS AND FTFTY CENTS ($77,203.50) � which sum is determined by multiplying Fifty Cents (.50�) times the number of residents in the area to be served by Provider, olus Twenty-five Thousand Dollars ($25,000.00) per ambulance used to Provide services -3- , � hereunder but not to exceed Fifty Thousand Dollars ($50,000.00). Pay- ments by the County of its obligation hereunder shall be made in twelve (12) monthly installments, each installment to be made not later than the tenth (lOth) of the month following the month of service. Provider agrees that the aforementioned payments by the County shall be the only financial obligation on the part of the County for any emergency ambulance services, expendable supplies, mileage, equipment, or any other costs, incurred by Provider to provide the emergency ambulance services covered by this agreement. For purposes of this agreement, the number of residents in the area served by Provider shall be as designated on the 1980 final population estimates for municipalities in Winnebago County as published by the Wisconsin Department of Administration, Bureau of Program Management, a copy of which will be attached hereto and made a part of this agreement when it becomes available. In order to process payments for services rendered based on popula- tion figures, the parties hereto agree to temporarily use the Wisconsin State Data Center, Preliminary Results, 1980 Decennial Census, dated April 1, 1980, for determination of such payments, with the understanding that an adjustment in such payments may be necessary when the 1980 final population figure estimates are released by the Wisconsin Department of Administration. AMBULANCE RATES, BILLINGS AND COLLECTIONS: Provider agrees to establish the rate to be charged for emergency ambulance service rendered pursuant to this agreement. Provider agrees that the ambulance rate established for emergency ambulance service rendered by Provider outside Provider's municipal boundaries shall not exceed Seventy-five and No/100 Dollars ($75.00) per call. Provider agrees to do the billing and collections of all charges made for emergency ambulance services rendered pursuant to this agreement. -4- i �r Any such collections made by Provider shall be the sole property of the Provider and the County agrees it wi11 not make any claim therefor. 10. TERMINATION: The County or Provider may terminate this agreement at any time upon advance written notice of not less than six (6) months. IT IS UNDERSTOOD by the County and Provider that a11 agreements and understandings have been embodied in this agreement and no changes shall be made herein except in writing and duly signed by the County and the Provider. THIS AGREEMENT is made and entered into pursuant to the authority granted by sec. 59.07(41) and sec. 66.30, Stats. IN I�IITNESS WHEREOF, the parties hereto have executed this agreement on the date first above written. In Presence Of: �� u—�- .c, .1�� , In Presence Of: � 7 7 �1 ,� � , 1� �-C t�' l This Instrur^ent drafted by: Gerald L. Engeldinger Coroora*_ion Counsel lJinnebago County, blisconsin WINNEBAGO COUNTY ("COUNTY") B,Y:�. ' / 4�; X L_— �~�"'T14� � � James . Coughlin, Coµrt y Executive {� � c�,,.�., -f,-P n� Dorothy L. Pr op, County le k THE CITY OF,OSHKOS % .O � . By: % ,�l��l, �TTiam �. rue , "PROVIDER") Title) /� _'(��'1it�� _.�� Converse C. Marks, C�.ty' lerk (Title) -5- APPR VED ; ;_:;� 1 2 1931. 7mm (Al %l�7�(1 —�S�P .cirv nrioeHrr (1[NN(14M WISI'ONSIN J c ExHZlS1T "A." — r�t.n�n:�nni i� c ................. AHBUL.�NCE SERVZCE AGREE?SENT DESIGNATED AREAS TO BE SERVED BY EMERGE"iCY AH$IILANCE SERVICE PROVIDfiRS: GOLD CROSS AMBQLANCE OF THE FOX CITIES, INC. That area located vithia Winnebago County aa follove: City of Appleton (oart) City of Pienasha 2ovn of Kenasha lying East of Little Lake Butte des Fforts City of Neenah Tovn of Neenah Town of tSenasha lyiag Beet of Little Lake Butte des Horts Tovn of Vinland lying North of Couaty 'Irunk CG 'fovn of Clayton iovn of iTiaehester lying East of State Highway 110 Soath and gortk af State H3gh�aay 110 iJest CITY OF OS$ROSH That area located vithin H3aaebago County as follovs: C3ty of Oahkosh • Tovn of Oshkosh . Sova of Vialand lyiag South of Couaty Trunk GG (Also Town of Black Wolf and Tawn of Nekimi upon written request of the County) OS&RQSH AMBULANCE SERVICE ihat area loeateu v;tfiia Wianebago County as followa: Sovn of Algoma 2owa of B2aek tiolf iovn of Nekimi iovn of Aepeuskun iow of Omro ?ovn of Poygan 2own of Rushford iovn of IItiea ?ovn of iliaehest�r 2ying West of State Higttway I10 South • and South of State Highway 110 FTest Soan o f 4linne conne 9illage of Wianecnnae City of Omro Lake Butte dee Morts Bxidge FREHONT-LIOLF RZVER E.H.S., LTD. Tha[ area located �ithin Tiianeba�o Countq as follovs: ?own of Aolf River r Jo Lene A. Maternowski GERALD L. ENGELOIHGER Corpermion Coumai :��. t i � i l �" i+1"C "�,.q . ''��. t� ' i ;� _ � ��1 �'4� 1 a..� ' 4��+�� l 9. - OFFICE OF CORPORATION COUNSEL WINNEBAGO COUNTY Counhouse Oshkosh, Wisconsin 54903 Telephone 414-235-2.`.OG January 22, 1981 Mr. John Pence, City Attorney City of Oshkosh City Hall Oshkosh, Wisconsin 54903 Gold Cross Ambulance Service of the Fox Cities, Inc. 3003 West College Avenue Appleton, Wisconsin 54911 Oshkosh Ambulance Service 2022 Jackson Drive Oshkosh, Wisconsin 54901 Fremont-Wolf River E.M.S., Ltd. P. 0. Box 393 Fremont, Wisconsin 54940 Re: Emergency Ambulance Service Agreement/Winnebago County Gentlemen: �6�b0teeNCAxkXRkXXX Assistant Enclosed please find two copies of the above caotioned agreement which have been executed by approoriate County officials. If same meets with your approval, please arrange to have both Copies of the agreement properly executed and witnessed and return one signed copy to the undersigned. You may retain one copy r'or your fi7es. As in the past, it will be necessary for you to furnish Winnebago County with a certificate of insurance indicatina that you are in compliance with the insurance requirements set forth in the aareement. GLE:gs Enclosure cc: Mr. Richard Olson, Chairman E.M.S. Committee Yours very truly, ��lf.l�![�l.� � Gerald L. Engeldinger Corporation Counsel WISCONSIN STATE DATA CENTER PRELIMINARY RESULTS 1980 DECENNIAL CENSUS 4/1/80 WINNEBAGO COUNTY: TOWN OF ALGOMA TOIdN OF BLACK WOLF TOWN OF CLAYTON TOWN OF MENASHA TOWN OF NEENAH TOWN OF NEKIMI TOWN OF NEPEUSKUN TOWN OF OMRO TOWN OF OSHKOSH TOWN OF POYGAN TOWN OF RUSHFORD TOWN OF UTICA TOWN OF VINLAND TOWN OF WINCHESTER TOWN OF WINNECONNE TOWN OF WOLF RIVER VILLAGE OF WINNECONNE CITY OF APPLETON (PART) CITY OF MEPJASHA CITY OF NEENAH CITY OF OMRO CITY OF OSHKOSH 3213 2325 2352 11385 3558 1512 682 1682 4418 893 1427 1040 1638 * 1260 ** 1588 1053 1933 5 14738 22405 2764 49608 131479 (Total) * 76.71°6(Town of Vinland) to Gold Cross Ambulance of Appleton, Inc. 23.29%(Town of Vinland) to City of Oshkosh. ** 50� (Town of Winchester) to Gold Cross Ambulance of Appleton, Inc. 50� (Town of Winchester) to Oshkosh Ambulance Service. rt.�y T i`''k _ ��\.i � 'y .-��." _ .-'� w". .�. ��. _ . �.� :� � NAME AND AG{;pp�5 Ch �;ENCY . AMERICAN X/S UNDERWRITERS � COMPANIES AFFORDING COVERAGES 511 ARCADIAN AVENUE coMPnnv. WAUKESHA, WISCONSIN 53187 �ETTE" AWESTERN WORLD IN! . � .� COMPAAV � . LETTER NAME nND ADDRESS OF INSURED A ' COMPPNV ■ � . CITY OF.OSHKOSH AMBULANCE SERVICE �EnER v 215 CHURCH AVENUE couaanv � OSHKOSH, WISCONSIN 54901 �EZTER i nis �s to ot any cc terms, ei COMPANY i LETTEfi or TYPEOFINSURANCE COMPANY C LETTEN L. � listed Celow have heen issued !o the insurty �amed above and are in brce a! this time. NoMlthstantling respect to which ihis certiticate may be issuetl or may peRaiq the insu2nce attordetl by t`e �qhcies tle '1 �IICIBS � . . POIICYNUMBER � Po�� M�� E%PIRATION OATE � ❑ COM�RENENSIVE FORM � ❑ PREMISES-0PERATIONS � E%P1O510N nND COLLAPSE HA2RRD ❑ UNOEitGAOUND HA2ARD � PFOOUCTS%COMPIETED OPERqTI0N5 MAZARD ❑ CCNTRACTU4L INSURANCE � BROAD FOFM PFOVERTY - �AMnGE ❑ INDEPENOENT CONTRPCTOI ❑ PERSOrvA� INIURY , � AUTOM091LE LIAdIUTY ' ❑ CONPHEHENSwE FORM ❑ OwNED ❑ MIRED ❑ NON-0WNED EXCE55 LIASILITY ❑ LIMBRELIA FOkM ❑ OTHEftTHANUMBRELLA FORN �':70RXERS' COMPENSATIO and EMPIOVEP.S' LIA6ILITY OTHER A BULPNCE DRIVERS � ATTENDANTS MALPRACTICE . xif,e-�:.'� .a,�..�r,.o"'.a.,�'"`.L?ii'S':`a '''��i�.•i IJESCrtIF ,:Y JF OPEHFTIGN�/LOCATIOti5Nf4QES GLA 105288 BODILYINJURY f PROGERTV DAMRGE f BOOILY INJURV AN� PROPEBTY DP.MqGE S COMBiNEO PERSONl4 INJURY BGDIU'INIURV t (EACH PERSON) BOOILYINJURV t � (EACH ACCIDENT) PROPEP.TY 04MAGE S BODIIY �nJURY ANO PROPEATY Dr1MAGE E � CCN��NE9 eooicr:n:uar arvo PROPERTY DAMnGE S COMBtNED 5t,1?IITOFY � �ect to au me , AGG� f f S f T �� A �k' �� v� f .Eac�..cc��ocr�r, /21/81 $500,�00.00 ANY O�VE CLAIM $500,000.00 ANNUAL AGGREG� Cancellation: Should any of the above desr�b=_d policies �e cancelkd 6efore ths expiration date thereof. the issu�ng ccm- pany s;ill andeavo! to mail 1� days wr�trer notic2 to the belo�.v named certiiicate hoider. but fai�ure to mail such no!ice shail impose no obltgation or liabilitq nf any kind upon Yhe comoany_ I W'I NNEB�AGOc COUNTY nF`� ;INSURANCE ADMINISTRATOR ',OSHKOSH, WISCONSIN 54901 I �--- ----..__-- _.: =� , „ � ;r.�e issueo-�_13�81 ' v c�c�ra. ;�� - �, NAME AN� ADDRE55 OF AGENCV AMERICAN X/S UNDERWRITERS 511 ARCADIAN AVENUE WAUKESHA, WISCONSIN 53187 CITY OF.OSHKOSH AMBULANCE SERVICE 215 CHURCH AVENUE OSHKOSH, WISCONSIN 54901 to certiy tn contrac( or �COMPANY LETTER � TVPEOFINSURANCE ❑ COMPREMENSIVE FpHM� ❑ PFEMISfS-0PERATIONS � EXPlO5i0N PND GOIIAFSE HAZAAO ❑ UNOERGROUNO H4ZARD � PFODUCTS.COMPLETED OPERAIION$ MAZARD ❑ CONTRPCTUPL IHSURRNCE � BROAO FORM PROPEATV DAMPGE ❑�j INDEPENDENT CONTRACTORS IJ PERSONAL INJURY � AUTOMOBILE LIABIIITY ❑ COMPHEHE.�SrvE FORM ❑ OWNFD ❑ Nir�o ❑ NOM-0WNED ❑ UMBRELLA FOFM � � OTHEPTHANUMBFE�LA FORM YtORKERS' CCMPENSATI( and EMPLOVEP.S' LIAAILITY MBULPNCE DRIVERS TTENDANTS MALPRAC�ICE �OESCRIFIibh OF �PEPqTIONS�LGCA(IOYSNEHiCIES COiS1PANIES AFFORDING COVERAGES COMPANV �E^ER AWESTERN WORLD IN� COMPdNY � LETTER COMPANY ■ . � LETfER \! COMPANY D LETTER COMPANV � LETTER may be issuetl or may POLICYNUMBER .. ' PoUCY D(PIRATION OATE GLA 105288 �deA by the policies tlescribetl herein scx+x�aw�a�cx EACH OCCURREM1 � ' BO�ILYINIURV f � PROPERTY DAM4GE S � BODI�YINJURYRNO PROVERTV DAMAGE � S COMBINED PERSONAL INJURY OODIt V �N.IURY = (E/CH PEFSONI BODILY INJURY s (EACH ACCIDENn PRpPEPTY DAMAGE S BODILY INJURY ANO PfYJPERTY DAMPGE _ BODI�`/ INJUfiY LN� I FROFtRTY DAMAGE f COMBiNED sraruro?v ject to al1 thn S�d� AGGREGATE f S f S i x . ,. .�` ..,�,� . . s � � dPCN4CC10FYi /21/81 $500,000.00 ANY ONE CLAIM $500�000.00 ANNUAL AGGREG Cincellation: Sf��ould any of tne above desrib=d poiicies oe canc::��.:�•7�be!ore the expiration datz thereof, the issuing com- ��' pany wiil endeavor to mail 1� days rvritten noti�e to the belew naned certifica'e holder. t�ut failure to �� rn�i! such noticeshall impose no obligat�on or liabi;ity of any kind upon the company. �^�... .,,+r� �. .: s�� . -ea-�F� v. � � .�o�Rev 41INNEBAGO COUNTY INSURANCE ADMINISTRATOR OSHKOSH, WISCONSI�d 54901 � �------------- --- ,,:�.a,-.. , -----� jp ��.�� ipAiE I55_�G 2 � 13 L�! �_ _ �- / , /�, /� _.�— , � __ �' . % ./��— . ,..G ��'�' �-ly= ��- �?`.,caiz - _. _ _..----� � ... , . - -. �. '.`�a� r�_�� ...-r�. �-j �: . � r..�..�� i,.�.+s.'a .i ,.-a.',i�aw,.3�NU!�'?�^n�>.)a..t?�+�ae� rvaME aNO aooa�=��ir ��rvcv � The ?'•'.orroe h�;ency Inc. 1429 Oregon Street Osnkosh, b1I 54901 E �ND ADORE55 JF lNSURE� C�. �7 0�, �Silli�.511 215 C�ZU,�ch ;venue Oshkosh, 4•II 54901 This is to!ertify [hat policies of insurance listed below have be� of any cont2ct or other dxument wi:h respr_! to which this t_ams. =zciusions antl conditions of such policies. ��UP�Y� � TYPCOLINiURrIfrCE ( IETTER ❑ COMPFEMENSWE fpRM ❑ PPEMISES—OPERATIONS � E%PLGS:ON AND COLLAPSE ('� NNZLRD L.� UNDERGROURD HhZARD � PAODUCTS LOMPLETED OPERATION$ HA2ARD ❑ CONTRA�TUAL INSURANCE � 9ROAD FORM P,4pPERTV DAMAGi ❑!�'7 IN�EFENOENT CONTFACiOP.S LJ FERSONAL INJURV � AUTOMOBILE LIABILITY A ��ir� COMiREHEN5IVE fOA,N 1�J OKNEO ♦��7 HIRED IyyJ NON-0`/�YF.^. ❑ U'ABRELLA FORM � OTNERTNANUMBREIL� FOP61 and EMPLCY� RS' 11A31Li�'i OTHER Uninsured �� to ne e may POLICY NUNBER B�61140?_7 1 40 1 ��_%i!.'�'9�i". COMPANtES ^:'FORDING COYERAGES �°M1;EN"Y A The :!o�e Insurance COMPANV � lER[R �1 $SOC.'� uted Indemni COMPANY ■ LETTER V COMPANY � IETTER COMPANV � LEiTER ned zbov= antl are in tor.-e a; ::� or may Certain, tbe insurance a PO��( Y EXPIFATICn DATE . by a term BODILY INJURY � S I s PROPERTY UAMAGE I 5 � S °"A INIURYPtiD / i FROPE?T"�JRMqGE E CO �tE:�vEC f PERSONAL INJURV I % BODILVINJURY $ 1 OOO f-� (EACHPEFSON) ) 7 , 4�22�81 sooi�r irv�uer s 1� 000 {� (EACHACCIDEiii� - ti FROPER.yOAMnGE 'LJ Q�;'��j A� BOOILViV;URYnND �� PROPERTV DAMAGE a BODILY INJURY AND I PRCF�r�;�iilAMAGE b CGNBINEO SLqTUTORV 3 � tl AGGFEGATE ueSCRPT:ON O: r :.oeqqN3:LJCfTIONS�dEFS:i,t.S . �':.. {:� *Li?�its for Bod_.1y Injur�� and Pro�erty Dama;e snorm above o71v a�nlr to ��': amh'tl^.rC°S. T�1ID1t5 'O_' Y'2i?'?1.i(j@I` Of vehic.'_�� covered unde� this fleet i�l policy are ;�50n,000/500,000 Bodil,,• InjurS� and ;�250,C00 iro-�ertv D2ma�e. s Canceliation: Sh _: �ny :,� �he above described po�icies be cancz'ed be �-� rne expirat �--� �, d�te thereof. the issuing com- ��-� pany witl enac=_��or to mail __1_Q.. days written notice te the !_ �'ow named ::ertificate holdet. but fa�ture to F�- � �� s�� :, notice shc�l impo�=.^r �o'�g ��iio�� :biii+,�-• ,,ny G'. .,,�,. : . ,sm.pany.� 't$1S 3�2T1c,-, and � �. �ts renresentat�ves �� 3 �'. " ' �DURESSOYG�nr�pCFT �' P ��'' � ' �i1ri�'l�'03T0 �'iOLl�'t�� ; c�,T`- � su=��l 7/�`il f�. P ...i.- � + • F� I i .Y.nn(�n .{Clr�"i... .. �n:: ) i i::� � .. , ...__ ' _' _. - il. ,yG� —�'� •_7 '-�! `C. ✓ _i.. . � �_ORi �e��. , J €_�: -- :or __ •enc�� !^� � . . . __.. . __ . . .. fY��. �'.^iIPG i_ ..i ` y�y�y�!.y��.�n��{.'�QHf_-`� .. .�� ' � " r:. :. - .v/Y. �,j� � • �Yl1'�3YT� ��+�ui� '"'e � K�i� � ve �� c�� n,. '�� -��L i �'y�F'!"S�l .:.v� J� _ g^ £ - + ... t� .:r , ... . _ �n i 1 . . .. �:. � ��° : ��"�" � ; x-.o.�i,K.,,. _ NAME ANO ADDHE55 OF AGENCY The i�ior.roe A�enc�� Inc. 1429 Oregon Street osnkosn, :�I 5'+901 E r1ND ADDRE55 QF InSUH[u Cit� of, Oshkosh 215 Church _'�venue oshkosh, wI �4go1 COMP�NV LET�EW [hat policies of insurance listed'oelow have o� other Eocument with respect to wtrich I �s a�d contlitions of such co�lcles. TVPEOFINSURnNCE � � COMPREHENSIVE iORM ❑ GFEMISES—OPERATIONS �E%PLOSIOY AND WLLA�SE HAZARD ❑ UNOERGROUNO MFZARO �PRJOUCiS/COMPLEfE� OPERA�iONS HAZAHD ❑ CONiRACiUT� INSURANCE �G'p<D FORM PROPERn' DAMaGE ❑ IMDEPERDEIVi CONTAaCTpi ❑ PERSONAI INJURY AUTOMOBILE L�ABILITY A � COMPREHENSIVE FORN ��/��+iNED jyJ HIFED � NON-0WNED � t1MFRELLA iOAM ❑ O�YERTHANUMBREILN FGaM and OTHER Uni*�sured :�� CC'dPA`�'�.'.S AFFaRDING COVERAGES EnER"� f=� The Jo^!e COMPANY � LEREF p$$(�` COMPANY � IETTER COMPANV � lErfEft COMoANY � LETTER � the insured named aCOV? are =_r= in torce at t may be issued or maypertain, the insurance POLICY NU!ABER B<� 6 11 40 27 40 POUCY ExN�R<iION OaTE ?! ted by the policies BODILYIfiIUPY � 5 PROPEAiY DAMAGE � S BODL. Y IYIURY ANO � PROPERTYOAMAGE S _ ' COMBMED � subjxt to all [^e n s 0) ACGQEGAiE s b f GERSONAL INJURY S BO�JILV�NJURV 5 1 �MO (EAGH PERSONI 5 1 ' OVv 1 BOOILY INIJRY 7 c�cH nccwervn �/�� PRpPEP.TYDRMAGE 2 v BOOI�V INJVFV >ND PROPERTY DAMAGE a BODICYIN)URYAND I PROPERTY OAMAGE s COM9INE� STNTU70FY 3 e.c x �cc � 4VtlOh pF OPF?ATIONS/LOCATIONSh'E111CLE5 *Li�its for �odily Injur� and ironert^ �^.�aoe sho�:;^ above onl�� apolv to ambula:^.cAs. Li^!its fo- remainder o` vehicles covered under this f?eet nol�c�* are ;�500,000/500,000 Bodi1� Injur�� and i250,000 Property Dama�e. CancellaYon: Snould any of the above described policies be cancetled t.=��ore the expiration date thereof, the iss�.:mg com- pany will endeavor to mail _.�.Q_ days written notice `.'�� the below named �ertificate holder. but faifure to r...:+! such notice sna:! imp.;se c� ohli�,ation or liab�!��ty of �r. ,'r.ind upon the co::ip::.•,.� 't$2 ^^'°2:7Cj 8Y1C% its renresentatives. 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