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Home My WebLink AboutBis-Pak Plan Page 5 Policy Number: X90139 Effective Date; 03-01-16 coverage item Premises Building Limit of Number Number Insurance Money and Securities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 001 003 Inside the Premises . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . , . , . , . . . , 10,000 Outside the Premises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 5,000 Accounts Receivable , . . . . . . . . . . . . . . . . • . . . . . . . . . . . . 001 003 25,000 Valuable Papers . . . . . :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 001 003 10,000 Business Income and Extra Expense . . . . . . . . . . . . . . . . . . . . • • . . 001 004 Actual Loss Sustained Money and Securities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 001 004 Inside the Premises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,000 Outside the Premises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,000 Accounts Receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 001 004 25,000 Valuable Papers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 001 004 10,000 BIS-PAKa PLAN Contractors AUDIT PERIOD Annual ADDITIONAL NAMED INSUREDS WHO IS AN INSURED Includes the fallowing Additional Named Insureds: NONE FIRST NAMED INSURED IS: ORGANIZATION OTHER THAN PARTNERSHIP, JOINT VENTURE OR LIMITED LIABILITY COMPANY { 80 01 03/02/16 cB-7000(12-08) lflf ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS- CB-7048(4-10) SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under jury or property damage occurring after: the fallowing: (1) All work including materials, parts or t31S-Floe BUSINESS LIABILITY AND MEDICAL EX- equipment furnished In connection with PENSES COVERAGE FORM such work, on the project (other than service, maintenance or repairs) to be 1. The following is added to Who Is An Insured: performed by or on behalf of the addi- Any person or organization shown In the Wrial insured(s) at the site of the cov- Schedule is also an insured, but only with re- ered operations has been completed; or spect to liability arising out of your ongoing 2 That portion of your wort( out of which operations performed for that insured. ( � the ijury or damage arises has been 2. With respect to the insurance afforded to these put to its intended use by any person or additional insureds,.the following exclusion is organization other than another contrac- added: for or subcontractor engaged in per- t. Exclusions forming operations for a principal as a This Insurance does not apply to bodily 1n- part of the same project, ,gcHEDULE Person or Organization (Name and Address) CITY OF APPLETON 100 N APPLETON ST APPLETON WI 54911 CITY OF KAUKAUNA 201 W 2ND ST KAUKAUNA Wi 54130 CITY OF FOND DU LAC 16o S MACY ST FOND DU LAC WI 54935 CITY OF OSHKOSH&ITS OFFICERS COUNCIL MGRS,AGENTS, EMPLOYEES& .PO BOX i 130 OSHKOSH WI 54903 JEFF FOUST EXCAVATING INC 2824 CLAIRVILLE RD OSHKOSH WI 54904 IL-7012(3-14) ASBESTOS EXCLUSION This endorsement modifies insurance provided under PRODUCT WITHDRAWAL COVERAGE PART PRODUCTS-COMPLETED OPERATIONS LIABILITY the following: COVERAGE FORM BIS-PAKO BUSINESS LIABILITY AND MEDICAL EX- RAILROAD PROTECTIVE LIABILITY COVERAGE FORM PENSE COVERAGE FORM The following exclusion is added; COMMERCIAL AUTO COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART Asbestos DIRECTORS'AND OFFICERS' LIABILITY COVERAGE This insurance does not apply to any bodily injury or PART property damage arising out of activities related to, EMPLOYEE BENEFITS LIABILITY COVERAGE PART but not limited to, manufacture, mining, storage, dis- ERRORS AND OMISSIONS COVERAGE PART tribution, installation, sale, use, e40suro to, service, GARAGE COVERAGE FORM testing for, repair, containment or removal of asbes- LIQUOR LIABILITY COVERAGE FORM tos, asbestos fibers, asbestos dust, or products con- OWNERS AND CONTRACTORS PROTECTIVE LIABIL- taining asbestos, ITY COVERAGE FORM POLLUTION LIABILITY COVERAGE FORM 1]]7 NOTICE OF CANCELLATION ]ENDORSEMENT IL-7002(10.90) All Coverage Parts Included in this policy are subject nonpayment of premium, we will mail advance notice # to the following condition: to the person(s) or organization(s) as shown In the if we cancel this policy, for any reason other than Schedule. SCHEDULE Person or Organization Advance Notice (Name and Address) (Days) CITY OF APPLETON 30 100 N APPLETON ST APPLETON WI 54911 CiTY OF KAUKAUNA 30 201 W 2ND ST KAUKAUNA WI 54130 CITY OF CLINTONVILLE 30 50 10TH ST CLINTONVILLE WI 54829 NORDIN DESIGN GROUP ING 30 N5841 STATE HIGHWAY 47 55 SHAWANO WI 54166 CITY OF OSHKOSH& ITS OFFICERS 30 COUNCIL MBRS,AGENTS, EMPLOYEES& PO BOX 1130 OSHKOSH Wl 54903 FUNQI OR BACTERIA EXCLUSION (LIABILITY) CS-0577(410) This endorsement modifies insurance provided under (2) Any loss, cost or expenses arlsing out of the following: the abating, testing for, monitoring, cleaning 131S-PAKO BUSINESS LIABILITY AND MEDICAL EX- up, removing, containing, treating, detox- PENSES COVERAGE FORM ifying, neutralizing, remedlating or disposing A. The following exclusion is added to Paragraph of, or in any way responding to, or assess- 1 under Excfuslons: ing the effects of, fungi or bacteria, by any t✓ung! or Bacteria insured or by any other person or entity. This exclusion does not apply to any fungi or (1) Bodily Injury, properly damage, personal In- bacteria that are, are on, or are contained in, a jury or advertising Injury which would not good or product intended for bodily consump- have occurred, in whole or in part, but for tion. the actual, alleged or threatened inhalation of, ingestion of, contact with, exposure to, g The following Medical definition is added to Liabilityand defieft Definitions:existence of, or presence of, any fungi orExpenses bacteria on or within a building or structure, "Fungi" means any type or forth of fungus, including Its contents, regardless of whether Including mold or mildew and any mycotoxlns, any other cause, event, material or product spores, scents or by-products produced or re- contributed concurrently or in any sequence leased by fungi, to such injury or damage. f