Public Safety & Welfare Committee
Regular MeetingVerona, WI · June 28, 2021
Minutes
CITY OF VERONA
MINUTES
PUBLIC SAFETY AND WELFARE COMMITTEE
June 28, 2021
Verona City Hall
1. Call to order: Evan Touchett called the meeting to order at 5:33 p.m.
2. Roll Call: Evan Touchett, and Katie Kohl were present. Heather Reekie was absent and
excused. Also present: Police Chief Bernie Coughlin, City Administrator Adam Sayre, and City
Clerk Holly Licht.
3. Public Comments: None
4. Approval of Minutes: Motion by Touchett, seconded by Kohl, to approve the minutes from
the June 14, 2021 Public Safety and Welfare Committee meeting. Motion carried 2-0.
5. Discussion and Possible Action Re: Special Event Permit application from Dee Baldock for
the Verona Area Community Theater, for the Play in the Parking Lot from 2:00 p.m. – 8:30
p.m. on July 16 & 17
The VACT will be putting on a play in the parking lot - "The Radio Play Disaster." The stage
will be on the east side of the building. There will be 3 shows (7/16 at 6:45pm-8:30pm, 7/17
at 2:00 p.m. and 6:45 p.m.) Tickets will be very limited ticketed (50 guests per show). In the
event it rains, play will be moved inside.
Alcohol will not be sold during this event and no VPD staff is necessary.
VACT will be asking VFD to use a small portion of their lot, parking will still be allowed in a
portion of theater lot.
Actors will have body microphones which will project through two speakers pointed in the
direction of the ice arena.
Motion by Kohl, seconded by Touchett, to recommend approval of Special Event Permit
application from Dee Baldock for the Verona Area Community Theater, for the Play in the
Parking Lot from 2:00 p.m. – 8:30 p.m. on July 16 & 17. Motion carried 2-0.
6. Discussion and Possible Action Re: Special Event Permit application from Phil Hoechst for
the Hop Haus Brewing Company 6th Anniversary Party from 12 p.m. – 10 p.m. on Saturday,
July 17, 2021
Phil Hoechst has applied for a Special Event Permit for an anniversary party on Saturday,
July 17, 2021, at Hop Haus Brewing Company, 231 S. Main Street. The business’s parking lot
will be used for seating, a food cart and live music, with metal barricades marking the
perimeter of the parking lot area. A temporary premise description amendment is required
for serving beer and wine in this area. Past events a VPD Officer has worked the events, but
no issues have occurred and Staff believes an Officer is not necessary for this event.
Motion by Kohl, seconded by Touchett, to recommend approval of Special Event Permit
application from Phil Hoechst for the Hop Haus Brewing Company 6th Anniversary Party
from 12 p.m. – 10 p.m. on Saturday, July 17, 2021. Motion carried 2-0.
7. Discussion and Possible Action Re: Special Event Permit application from Laura Ford-Harris,
Boys and Girls Club of Dane County, for the MOVE4BGC bike race on Saturday, July 17, 2021
from 7:30 a.m. – 10:30 a.m.
This is a fundraising event for the Boys and Girls Club of Dane County. This event has come
through Verona for several years. A portion of the 25-mile and 50-mile bike ride routes will
be coming through Verona. They are not requesting Police Department assistance this year,
and no road closures are necessary. This is a ride, not a race. Bicyclists will follow the rules
of the road.
Route in Verona will include: Military Ridge Bike Trail, south on CTH PB, right on Military
Ridge Rd, right on Whalen Rd, left on S. Main St, right on Prairie Heights Dr, left on Locust
Dr, left on Whispering Pines, right on Range Trail. The route will be properly marked with
tape on the pavement and volunteers will be staffed at busy intersections (Whalen @ S.
Main St) to ensure bicyclist stop appropriately. Volunteers know they cannot stop/direct
traffic. The majority of bicyclists will pass through Verona between 8:30 a.m. and 10:30
a.m.
The certificate of insurance received by the City of Verona from the Boys and Girls Club
expires on July 1, 2021. The event organizer is aware of this and will provide the City with
an updated/valid certificate of insurance before the event.
Motion by Kohl, seconded by Touchett, to approve a Special Event Permit application from
Laura Ford-Harris, Boys and Girls Club of Dane County, for the MOVE4BGC bike ride on
Saturday, July 17, 2021 from 7:30 a.m. – 10:30 a.m. contingent upon receipt of a valid
certificate of insurance. Motion carried 2-0.
8. Discussion and Possible Action Re: Change of Agent request from Kwik Trip, Inc., d/b/a Kwik
Trip #837, 400 E Verona Ave, Verona, WI 53593
Kwik Trip, Inc. has requested a change of agent for their Combination Class “A” and “Class
A” Liquor License at Kwik Trip #837 from Tracy Alvey to Robert Oldenburg.
Motion by Kohl, seconded by Touchett, to recommend approval of a Change of Agent
request from Kwik Trip, Inc., d/b/a Kwik Trip #837, 400 E Verona Ave, Verona, WI 53593
Motion carried 2-0.
9. Adjournment: Motion by Kohl, seconded by Touchett, to adjourn at 5:46 p.m. Motion
carried 2-0.
Adam Sayre, City Administrator
Agenda
City of Verona
PUBLIC SAFETY AND WELFARE COMMITTEE
Monday, June 28, 2021 AT 5:30 P.M.
COUNCIL CHAMBERS
VERONA CITY CENTER
111 LINCOLN STREET, VERONA, WI 53593
AGENDA
1. Call to order
2. Roll Call
3. Public Comments
4. Approval of Minutes from the June 14, 2021 Public Safety and Welfare Committee meeting.
5. Discussion and Possible Action Re: Special Event Permit application from Dee Baldock for the Verona
Area Community Theater, for the Play in the Parking Lot from 2:00 p.m. – 8:30 p.m. on July 16 & 17
6. Discussion and Possible Action Re: Special Event Permit application from Phil Hoechst for the Hop Haus
Brewing Company 6th Anniversary Party from 12 p.m. – 10 p.m. on Saturday, July 17, 2021
7. Discussion and Possible Action Re: Special Event Permit application from Laura Ford-Harris, Boys and
Girls Club of Dane County, for the MOVE4BGC bike race on Saturday, July 17, 2021 from 7:30 a.m. –
10:30 a.m.
8. Discussion and Possible Action Re: Change of Agent request from Kwik Trip, Inc., d/b/a Kwik Trip #837,
400 E Verona Ave, Verona, WI 53593
9. Adjournment
Heather Reekie, Chairperson
POSTED: Verona City Hall
Miller & Sons Market
Verona Public Library
City Web Page at: www.ci.verona.wi.us
Notice is hereby given that a quorum of the members of the City Council or other standing committees of the
City Council may be present at the meeting of the Public Safety and Welfare Committee to gather information
about a subject over which they have decision-making responsibility. The City Council and any other standing
committees will not take formal action at this meeting
IF YOU NEED AN INTERPRETER, MATERIALS IN ALTERNATIVE FORMATS OR OTHER ACCOMODATION TO ACCESS THE
MEETING, PLEASE CONTACT THE CITY CLERK AT 608-845-6495 AT LEAST 48 HOURS PRECEDING THE MEETING. EVERY
REASONABLE EFFORT WILL BE MADE TO ACCOMMODATE YOUR REQUEST.
CITY OF VERONA
MINUTES
PUBLIC SAFETY AND WELFARE COMMITTEE
June 14, 2021
Verona City Hall
1. Call to order: Heather Reekie called the meeting to order at 5:45 p.m.
2. Roll Call: Heather Reekie, Evan Touchett, and Katie Kohl were present. Also present: Police
Chief Bernie Coughlin, City Administrator Adam Sayre, Sergeant Jesse Christensen, and
Alderperson Chad Kemp.
3. Public Comments: None
4. Approval of Minutes: Motion by Touchett, seconded by Kohl, to approve the minutes from
the May 24, 2021 Public Safety and Welfare Committee meeting. Motion carried 3-0.
5. Discussion and Possible Action Re: Approval of alcohol licenses for the 2021-2022 licensing
period
Twenty-nine applications for 2021-2022 retail alcohol license renewals were received by the
Deputy City Clerk. Premises inspections by the Building Inspection Department are ongoing.
Approval of the applications will be contingent upon completion of building inspections. A
list of applicants is included in the Committee packet.
Motion by Reekie, seconded by Touchett, to recommend approval of the alcohol licenses
for 2021-2022 licensing period contingent upon completion of building inspections. Motion
carried 3-0.
6. Discussion and Possible Action Re: Approval of cigarette and tobacco products retail license
applications for the 2021-2022 licensing period
Eight applications for 2021-2022 cigarette and tobacco products retail licenses were
received by the Deputy City Clerk. The list of applicants is included in the Committee packet.
Motion by Reekie, seconded by Touchett, to recommend approval of cigarette and tobacco
products retail license applications for the 2021-2022 licensing period. Motion carried 3-0.
7. Discussion and Possible Action Re: A Special Event Permit application from Ken Ellingsen,
Race Day Events, for the Wisconsin Triterium Triathlon on Saturday, June 26, 2021 from
4:30 a.m. – 1 p.m.
Ryan Griessmeyer is available tonight to answer questions on behalf of the applicant.
Christensen provided an overview of the event. He stated the event should be smoother
this year as Nine Mound Road and the Military Ridge State Trail won’t be closed. There is a
slight change to the run route, but overall the route is similar to previous years. Fireman’s
Park will be open by noon to the public, but event staff will be breaking down and removing
the event after noon, but Bruce Street will be open to the public. The applicant will notify
the surrounding businesses of the road closure. Dane County Sheriff will assist the City with
traffic control. The Police Department has no concerns with the event and any approval
shall be contingent on a background check of the applicant. The applicant already has their
certificate of insurance in place. Griessmeyer will be point of contact at site during the
event.
Motion by Reekie, seconded by Touchett, to approve a special event permit application
from Ken Ellingsen, Race Day Events, for Wisconsin Triterium Triathlon on Saturday, June
26, 2021 from 4:30 a.m. to 1:00 p.m. contingent on completion of a background check of
the applicant.
8. Discussion and Possible Action Re: Ordinance No. 21-982 amending Section 10-1-12 of the
Code of Ordinances relating to the speed limit on Locust Drive
Touchett asked how much time Staff has put into this item.
Coughlin explained the Police Department has put in approximately 20-hours of time into
this issue. Staff doesn’t believe speed is an issue based upon the previous studies. Sight
issues at some locations could justify a speed reduction. The street has a sidewalk and
walking path along the sides of the road with bike lanes. Adjacent streets with sight line
intersections already have stop signs. The roadway section north of the bridge is different
than the section south of the bridge. Reducing speeds and adding a flashing beacon would
make it safer no different than any road.
Reekie stated she is not sure if flashing beacons are as effective as people believe. Locust
Drive is a straight street that is different than other residential streets that have curves.
Kohl stated Cross Country Road is 30 mph and driveways abut that roadway.
Coughlin stated Cross Country Road was the only street in the City that has a 30 mph speed
limit. The Police Department and Public Works Department look at street design and try to
strike a balance with the least amount of control and signage to not make it too difficult for
people to drive places in the City.
Touchett stated that when a school goes in this area, that might be the time to reduce the
speed and make changes. He asked what the speed limit is on Nine Mound Road?
Coughlin responded that Nine Mound Road is 25 mph.
Touchett wants to see data that supports the need to change the roadway speed. Touchett
doesn’t think it’s the right thing to do at this time.
Motion by Touchett, seconded by Kohl, to recommend disapproving of Ordinance No. 21-
982 amending Section 10-1-12 of the Code of Ordinances relating to the speed limit on
Locust Drive.
Reekie stated this is a difficult decision and wants to reevaluate the speed limit when a
school is built, but feels the request is not a significant change.
Motion carried 2-1.
9. Adjournment: Motion by Reekie, seconded by Kohl, to adjourn at 6:21 p.m. Motion carried
3-0.
Adam Sayre, City Administrator
PUBLIC SAFETY & WELFARE COMMITTEE – 2021-06-28
5. Discussion and Possible Action Re: A Special Event Permit application from Dee
Baldock for the Verona Area Community Theater, for the Play in the Parking Lot
from 2:00 p.m. – 8:30 p.m. on July 16 & 17, 2021
The VACT will be putting on a play in the parking lot - "The Radio Play Disaster."
The stage will be on the east side of the building. There will be 3 shows (7/16 at
6:45pm-8:30pm, 7/17 at 2:00 p.m. and 6:45 p.m.) Tickets will be very limited ticketed
(50 guests per show). In the event it rains, play will be moved inside.
Alcohol will not be sold during this event and no VPD staff is necessary.
VACT will be asking VFD to use a small portion of their lot, parking will still be
allowed in a portion of theater lot.
Actors will have body microphones which will project through two speakers pointed
in the direction of the ice arena.
Motion: To approve a Special Event Permit from Dee Baldock for the Verona Area
Community Theater, for the Play in the Parking Lot from 2:00 p.m. – 8:30 p.m. on
July 16 & 17
6. Discussion and Possible Action Re: A Special Event Permit application from Phil
Hoechst for the Hop Haus Brewing Company 6th Anniversary Party from 12 p.m. –
10 p.m. on Saturday, July 17, 2021
Phil Hoechst has applied for a Special Event Permit for an anniversary party on
Saturday, July 17, 2021, at Hop Haus Brewing Company, 231 S. Main Street. The
business’s parking lot will be used for seating, a food cart and live music, with metal
barricades marking the perimeter of the parking lot area. A temporary premise
description amendment is required for serving beer and wine in this area.
Motion: To recommend to the Common Council to approve a Special Event Permit
for the Hop Haus Brewing Company Anniversary Party from 12 p.m. – 10 p.m. on
Saturday, July 17, 2021
7. Discussion and Possible Action Re: A Special Event Permit application from Laura
Ford-Harris, Boys and Girls Club of Dane County, for the MOVE4BGC bike ride on
Saturday, July 17, 2021 from 7:30 a.m. – 10:30 a.m.
This is a fundraising event for the Boys and Girls Club of Dane County. This event
has come through Verona for several years. A portion of the 25-mile and 50-mile
bike ride routes will be coming through Verona. They are not requesting Police
Department assistance this year, and no road closures are necessary. This is a ride,
not a race. Bicyclists will follow the rules of the road.
Route in Verona will include: Military Ridge Bike Trail, south on CTH PB, right on
Military Ridge Rd, right on Whalen Rd, left on S. Main St, right on Prairie Heights Dr,
left on Locust Dr, left on Whispering Pines, right on Range Trail. The route will be
properly marked with tape on the pavement and volunteers will be staffed at busy
intersections (Whalen @ S. Main St) to ensure bicyclist stop appropriately.
Volunteers know they cannot stop/direct traffic. The majority of bicyclists will pass
through Verona between 8:30 a.m. and 10:30 a.m.
The certificate of insurance received by the City of Verona from the Boys and Girls
Club expires on July 1, 2021. The event organizer is aware of this and will provide
the City with an updated/valid certificate of insurance before the event.
Motion: To approve a Special Event Permit for the Boys and Girls Club of Dane
County, for the MOVE4BGC bike ride on Saturday, July 17, 2021 from 7:30 a.m. –
10:30 a.m. contingent upon receipt of a valid Certificate of Insurance.
8. Discussion and Possible Action Re: A Change of Agent request from Kwik Trip, Inc.,
d/b/a Kwik Trip #837, 400 E Verona Ave, Verona, WI 53593
Kwik Trip, Inc. has requested a change of agent for their Combination Class “A” and
“Class A” Liquor License at Kwik Trip #837 from Tracy Alvey to Robert Oldenburg.
Motion: To recommend to the Common Council to approve a Change of Agent
request for Kwik Trip #837, 400 E Verona Ave, Verona, WI 53593
Date:._----l't,�/.u..£ ,J..J,/,;:J...�/--
,
CITY OF VERONA
Account#: 100-44910
APPLICATION FOR A SPECIAL EVENT/NEIGHBORHOOD EVENT PERMIT
For Parades, Runs, Walks, Bicycle Events, Triathlons, Festivals, Neighborhood Events, etc.
*All required application materials must be submitted at least 45 days prior to the event. Failure to meet this requirement may
result in the denial of the application pursuant to Section 7-7-l(h) of the City of Verona Code of Ordinances*
Application Fee:
$150.00 + any additional fees
Non-Profit Organization: $50.00 + any additional fees
REQUIRED INFORMATION
Please include the following information/materials regarding the event with your application:
!QI' A copy of the applicant's Driver's License
g/° Route map and description and/or map of event layout
IE1 Certificate of Insurance - at least 30 days prior to event
APPLICANT INFORMATION
Name:__uD-.U-____.....,,kfc.;...L.L, ___....,{d=a=/.=°d.=()=d,£:;..;;:..J!__ Phone: (el)f( ·- -3-3 .J. _.. 7??/
First M.I. Last
Driver License#:
Email:
AGENCY /ORGANIZATION INFORMATION
Name: \).JJ.V-P?'l./i kr"...ut LPYJJr.11, t>...,.�
Phone:_.=.kc.=: - =--
3..[3._l,:).
'----' :;..__ ____
-_7_9_'1{
Address: /P 2 J-} /-"J LP (,1 '81 5:35'13
If this is a non-profit organization, please provide your EIN number for verification:
EVENT INFORMATION
Name of Event: I!� In �fk),1:z �c Type of event._-.L;J /� --J�-----
/ T ___;_,,.
jC,J:;7tto �.'#;
Event date(s}: I,,1..•./±f I UJ { I/ Event time(s): ..J u IL( 17 ,9. ! ()tJ tr. J,, .' tf.5
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Set up Start Time: *J t t>t> Sa-f. l'Joopt
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Tear Down End Time: 1 .' 170
]:n t!"-� �.-1 �l r1 ,, w� tA--'1/I ,��,_,,,,., ins'tk.J.n -/--kA-k-,,
(Application Continues on Reverse)
Last updated
Date:______
Initials: ------
EVENT CONTACTS
PLEASE LIST NAMES, LOCATIONS AND CELL PHONE NUMBERS OF ON-SITE EVENT CONTACT PERSONS
NAME DOB LOCATION AT EVENT TIME ON-SITE CELL PHONE
as shown on ID (Ex: Race Start, Supply (Ex: 10 a.m. to
Tent etc.) 2p.m.)
VftCT ���? i; .. ; 5- 1
� 64i ,,lp c)... '/t)._3 j__/ ,,, L.o/,? 5/ 5d i;l---"'1
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APPLICATION PROCEDURES
1. Application and all required materials shall be submitted to the City Clerk a minimum of 45
days prior to the event. (Section 7-7-1(h) of the City of Verona Code of Ordinances)
2. Upon verification of the application the City Clerk shall submit the application to the Police Chief for
further review.
3. The applicant will be contacted by the Police Department Staff to review event route and the
need for on- site police officers or City staff at the event.
4. The applicant is subject to a background check.
5. All police traffic control/city staff time incurred shall be billed to the applicant upon the completion
of the event.
6. The applicant may be required to attend a Public Safety and Welfare Committee meeting
and/or a Common Council meeting at which the event application will be reviewed for
approval.
7. Once the application is approved by the appropriate official(s) the permit will be issued.
APPLICANT SIGNATURE
PLEASE READ CAREFULLY BEFORE SIGNING
I understand the application and event requirements and agree to adhere to all applicable federal, state, and
municipal laws in addition to the requirements on the application. I agree to pay any invoices received from the
City of Verona for staff time at the event within 30 days of the invoice date. I understand that failure to adhere to
any application requirements or any federal, state or municipal laws involving the event will result in the denial of
the application or immediate termination of the event. The violation of federal, state or municipal laws will be
subject to applicable fines and penalties.
1 1
Applicant Signature Date
Once application is approved, the permit will be issued to applicant via email.
A copy of the permit must be available at event for conformation.
CITY OF VERONA
AMPLIFICATION DEVICE PERMIT APPLICATION
•:• Please attach a sketch of the outdoor area indicating where music or other amplification will be
located/played.
Please answer the following questions.
>" Name of Host/Business/Event:
V .2 nn?t? 4- r"
� .::::t (a n-i l'/,'1 u. //1 i +y :-(h .eA- .f.. LV
>" Address of where the event will take place:
I {)_2 Lin Cb(V7 s+.
}:>- Email Address: Phone Number:
>" Hours during whjfh amplification will be used: _,,,I)
ftrr:-r. :!t�il.f I 7
T1.t. ,1 /r,i i-1
From ----1L._: !:f.S_ a.m.l§)to __2_: 3t:> a.m./� ,,,1, ,' d! -- 4.1/)0141'
(P
>" Requested duration or date of the permit (e.g. May-Oct)
.July 16//7
>" What type of music will be playing?
D Live Band
D Recorded Music
D Acoustic
� Other: VIJ)LR5 d, l?1 12/J /Jo.Ra I 11
I
>" Type of amplification:
>" Applicant Signature
' I ,
Signature Date
Approval:
Police Chief Signature Date
Informational Questions No Yes Notes
Was a Special Event Permit previously approved in times
1
past for this event?
✔
2 Will there be outdoor amplified sound? ✔ Additional application required.
Will alcohol be sold, served or consumed? Additional licenses may be
3 ✔ required.
4 Are you requesting any City streets to be closed to traffic? ✔ See Below*
Will your event use County, State or US Highways? If yes, please provide a map clearly
marking the highways that will be
5 ✔
used. Additional permission from
the County is required.
Will park, conservancy land, or trails be used? If so, have Contact Parks Department:
you reserved a park, pavilion, or any other city facilities for 845-6695
the event? If using park facilities, the
6 ✔
application will not go before the
Public Safety Committee without
Parks Department approval.
Will items or services be sold or given away at this event? If yes, please attach a list of types
7 ✔
of items or services.
Does this event involve a plan for tents, stages, inflatable Include on event layout map.
8 ✔
bounce houses or temporary structures?
Does your event include the use of fireworks, rockets, Must receive written approval from
9 lasers, other pyrotechnics, or open flame? ✔ Fire Chief or his designee. 608-845-
9401
10 Do you plan to provide portable toilets at your event? ✔
Will your event have dedicated coverage by an Emergency
11 ✔
Medical Provider?
Is this a race or timed event where participants need the If traffic control is desired, a police
12 ✔
right of way on City streets? officer is required, per WI Law.
Will there be a clear path of travel (min. 18’ wide) for
13 ✔
emergency vehicles throughout your event?
Does your event include running or biking that will need a Posting of No Parking signs by PD
14 ✔
dedicated lane of travel on City streets? will be needed and billed to event.
*If you answered YES to street closures, please attach a map/diagram of the portion(s) of street you wish
to have closed for your event. Please include street names and as much information as possible.
If you are NOT intending to close any City Streets, or request the right of way, but intend to use City Streets,
you will share the street with vehicular traffic and agree to abide by all traffic laws. Failure to comply with
traffic laws will result in the immediate termination of all event activities.
*Applicant Initial Here:
DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 5/19/2021
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME: Polly Fleming
PHONE FAX
C4 Insurance Services, LLC (A/C, No, Ext): 6086406026 (A/C, No):
E-MAIL
14 Ellis Potter Ct ADDRESS: polly@c4ins.com
INSURER(S) AFFORDING COVERAGE NAIC #
Madison WI 53711 INSURER A : ERIE INS EXCH 26271
INSURED INSURER B :
HOP HAUS BREWING COMPANY LLC INSURER C :
1105 TAMARACK WAY INSURER D :
INSURER E :
VERONA WI 53593-2103 INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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 BY 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.
INSR ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
✘ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE
DAMAGE TO RENTED
$ 1,000,000
CLAIMS-MADE ✘ OCCUR PREMISES (Ea occurrence) $ 1,000,000
MED EXP (Any one person) $ 5,000
A Y Q42-2350876 06/23/2020 06/23/2021 PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
PRO-
POLICY JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION PER OTH-
STATUTE ER
AND EMPLOYERS' LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 100,000
A OFFICER/MEMBER EXCLUDED? N/A Q90-2300726 06/23/2020 06/23/2021
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 100,000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Verona ACCORDANCE WITH THE POLICY PROVISIONS.
111 Lincoln St AUTHORIZED REPRESENTATIVE
Verona WI 53593
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