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o ; Bi <br /> Or , . , Policy Number: <br /> • - • • • • - • - )MINU 21-02 <br /> NAME AND ADDRESS OF AGENCY COMPANY <br /> /0"N'r MENDEL S. KALIFF INSURANCE Lloyd's U.S. <br /> 70 N.E. Loop410 Suite 440 ' <br /> +' Effective an 1,19 <br /> San Antonio, Texas 78216 >n 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 fl <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. Coins. <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 <br /> I ❑ Sched I d Form Tk Comprehensive Form Bodily Injury $ $ <br /> Premises/Operations <br /> Products/Completed Operations Property Damage $ $ <br /> 1 �Contractual Bodily Injury & <br /> T {Other (specify below) Property Damage $ 1,000,00 $ None <br /> Y ❑ Combined Med.Pay. $ Per $ Per <br /> Personal Injury Person Accident ❑ A ❑ B ❑C <br /> Personal Injury $ Incl. <br /> Limits of Liability <br /> A ❑ Liability ❑ Non-owned ❑ Hired Bodily Injury(Each Person) $ <br /> U <br /> _ T ❑ Comprehensive-Deductible $ Bodily Injury(Each Accident) $ <br /> 0 ❑ Collision-Deductible $ <br /> M <br /> 0 ❑ Medical Payments $ Property Damage $ <br /> B <br /> 1 ❑ Uninsured Motorist $ <br /> L ❑ No Fault (specify): Bodily Injury & Property Damage <br /> E <br /> ❑ Other (specify): Combined $ <br /> ❑ WORKERS' COMPENSATION — Statutory Limits (specify states below) ❑ EMPLOYERS' LIABILITY — Limit $ <br /> SPECIAL CONDITIONSIOTHER COVERAGES <br /> a Includes $1 Million Participant Liability <br /> Participant Accidental Death $3,000; Excess Medical $3,000 with $200 Ded. <br /> 9� 30 Day Notice Prior to Cancellation <br /> NAME AND ADDRESS OF ❑ MORTGAGEE ❑ LOSS PAYEE L>^J AOD'L INSURED <br /> MENDEL S. KALIFF <br /> Lino Lakes BMX #1059 LOAN NUMBER <br /> David Rhode <br /> 2816 Blackstone <br /> St . Louis Park, MN 55416 <br /> City of Lino Lakes , its Officers B 1/22 7 <br /> and Employees Signature of Auth i e Representative Date <br /> ACORD 75(11/77-0 <br />