06/01/1987 Park Board Packet - Laserfiche WebLink

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®r e so Policy Number: Bi • • • . • - 21-02 NAME AND ADDRESS OF AGENCY -COMPANY - - MENDEL S. KALIFF INSURANCE Lloyd's U.S. 70 N.E. Loop 410, Suite 440 Effective an 19 San Antonio, Texas 78216 Expires [J(12:01 am ❑ Noon Jan 1,19 88 ❑This binder is issued to extend coverage in the above named company per expiring policy q (exceDt as noted below) NAME AND MAILING ADDRESS OF INSURED Description of Operation/Vehicles/Property AMERICAN BICYCLE ASSOCIATION, INC. 8620 N. New Braunfels, #311 San Antonio, Texas 78217 I Type and Location of Property Coverage/Perils/Forms Amt of Insurance Ded. coins. P R 0 P E R T Y Type of Insurance Coverage/Forms Limits of Liability L Each Occurrence Aggregate i ❑ ScheduI d Form LXX Comprehensive Form Bodily Injury $ $ Premises/Operations XX Products!Completed Operations Property Damage $ $ Contractual Bodily Injury & 1 Y (}(Other (specify below) Property Damage $ 1,000,00S None - Med. Pay. $ Pr S Pei Person Accide nt Incl. r� Personal Injury Pe I El A. ❑ B C Personal In)ury $ Limits of Liability U Liability Non owi;e� — Hired y Injur _ " a cr,j $ `." T L 1 Comprehensive-Deductible $ Bodily Injury ,E�, a Acc cent; $ M ❑ Collision-Deductible $ — 0 ❑ Medical Payments $ Property Damage $ B ) ! J Uninsured Motorist S EL No Fault (specify): Bodily Injury & Property Damage L ' Other (specify): Ccrnr�,in�-d L_J 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 L✓ TOSS PAYEE YJ ADD L INSURED - MENDEL S. KALIFF ino Lakes BMX #1059 David Rhode 2816 Blackstone St. Louis Park, MN 55416 City of Lino Lakes , its Officers By: 1/22 7 and Employees Si,_-nature uf Auth i e Representative Date ACORD 75 it 1/77-c)