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1 BA NdfXXX <br /> Of • • • Policy Number: <br /> NA,,UE AND ADDRESS OF AGENCY COMPANY <br /> MENDEL S. KALIFF INSURANCE Lloyd's U.S. <br /> 70 N.E. Loop 410, Suite 440 Effective A4 Jan 1,19 87 <br /> San Antonio, Texas 78216 Expires [:::� 12:01 am ❑ Noon Jan 1,19 88 <br /> []This binder is issued to extend coverage in the above named <br /> company per expiring policy # <br /> (except as noted below) <br /> NAME AND MAILING ADDRESS OF INSURED Description of Operation/Vehicles/Property <br /> AMERICAN BICYCLE ASSOCIATION, INC. <br /> 8620 N. New Braunfels, #311 <br /> San Antonio, Texas 78217 <br /> Type and Location of Property Coverage!Perils/Forms Amt of Insurance Ded. cons. <br /> I <br /> P <br /> R <br /> 0 <br /> P <br /> E <br /> R <br /> T <br /> Y <br /> Type of Insurance Coverage/Forms Limits of Liability <br /> Each Occurrence Aggregate <br /> L ❑ Scheduledr Bodily Injury $ $ <br /> f� Form L��{ Comprehensive Form <br /> A tin�tt' Premises/Operations <br /> u' Products/Completed Operaticns Property Damage $ $ <br /> j I Contractual Bodily Injury & <br /> T Other (specify below) Property Damage $ 1 ,000,00 $ None <br /> Y �' Med. Pay. $ Per $ Per ( Combined <br /> Person Accident r-- I <br /> Personal Injury El ❑ B L C Personal Injury $ Incl. <br /> Limits of Liability <br /> A ❑ Liability ' Non-owned L Mired Bodily Injury(Each, Person) $ <br /> T ❑ Comprehensive-Deductible $ I Bodily Injury(Each Accident) $ <br /> 0 ❑ Collision-Deductible $ <br /> M <br /> O ❑ Medical Payments $ Property Damage $ <br /> B ❑ Uninsured Motorist $ <br /> E El No Fault (specify): Bodily Injury & Property Damage <br /> ❑ Other (specify): Combined $ <br /> ❑ WORKERS' COMPENSATION — Statutory Limits (specify states below) _ EMPLOYERS' LIABILITY — Limit $ <br /> SPECIAL CONDITIONS/OTHER COVERAGES <br /> Participant Accidental Death $3,000; Excess Medical $3,000 with $200 Ded. <br /> r, <br /> NAME AND ADDRESS OF ❑ MORTGAGEE ❑' LOSS PAYEE LJ ADD L INSURED <br /> Lino Lakes BMX #1059 MENDEL S. KALIFF <br /> David Rhode LOAN NUMBER <br /> 2816 Blackstone Avenue, South <br /> St. Louis Park, MN 55416 -� <br /> Neil Schuldt <br /> City Of Lino Lakes Signatureot Authorized Representative Date <br /> ACORD 75(11/77-c) <br />