06/01/1987 Park Board Packet - Laserfiche WebLink

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Bi Or . • . • Policy Number: • • �- • • • 0 • • • X2XXJ01Z 21-0 2 NAME AND ADDRESS OF AGENCY COMPANY MENDEL S. KALIFF INSURANCE Lloyd's U.S. 70 N.E. Loop 410, Suite 440 Effective12:01 an 1,19 San Antonio, Texas 78216 Expires [� 12:01 am ❑ Noon Jan 1,19 88 ❑This binder is issued to extend coverage in the above named company per expiring policy # (except as noted below) NAME AND MAILING ADDRESS OF INSURED Description of Operation I Vehicles/Property AMERICAN BICYCLE ASSOCIATION, INC. 8620 N. New Braunfels, #311 San Antonio, Texas 78217 Type and Location of Property Coverage/Perils/Forms Amt of Insurance Ded. cons. P R 0 L0. P E R Y t1 � S Limits of Liability Type of Insurance Each Occurrence Aggregate L 1 ElScheduled Form LXpt Comp / $ $ Premises/OperationsL In — Products/Completed Operations----- Property Damage $ $ 1 TC Contractual Bodily Injury & T Other (specify below) (Property Damage $ 1,000,00 $ None Y ❑ Med. Pay. $ Per $ Per Combined Personal Injury Person Accident _ ❑ A ❑ g ❑C Personal Injury ��$ Incl. Limits of Liability A ❑ Liability ❑ Non-owned ❑ Hired Bodily Injury(Each Person) $ U T ❑ Comprehensive-Deductible $ Bodily Injury(Each Accident) $ O ❑ Collision-Deductible $ M O ❑ Medical Payments $ Property Damage $ B 1 ❑ Uninsured Motorist $ L ❑ No Fault (specify): Bodily Injury & Property Damage E, ❑ Other (specify): Combined $ ❑ WORKERS' COMPENSATION — Statutory Limits (specify states below) ❑ EMPLOYERS' LIABILITY — Limit $ SPECIAL CONDITIONS/OTHER COVERAGES Includes $1 Million Participant Liability Participant Accidental Death $3,000; Excess Medical $3,000 with $200 Ded. 30 Day Notice Prior to Cancellation NAME AND ADDRESS OF ❑ MORTGAGEE LJ LOSS PAYEE C ADD'L INSURED MENDEL S. KALIFF ,,�ino Lakes BMX #1059 LOAN NUMBER avid Rhode 2816 Blackstone St . Louis Park, MN 55416 City of Lino Lakes , its Officers B : 1/22 7 and Employees Signature of AuthijifehelpresenNtive Date ACORD 75(11/77-c)