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CERTIFICATE OF INSURANCE 122-1199--92 <br /> 9986 . ISSUEDATEM, 1 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS <br /> K & K INSURANCE AGENCY, INC. NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, <br /> EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> 1712 MAGNAVOX WAY <br /> P.O. BOX 2338 COMPANIES AFFORDING COVERAGE <br /> FORT WAYNE, IN 46801 <br /> — COMPANY <br /> • <br /> INSURED LETTER A • TRAN4AMFRTrA INLS, COMP , <br /> USA AMATEUR BOXING FEDERATION COMPANY B <br /> LETTER <br /> UPPER MIDWEST GOLDEN GLOVES <br /> 1750 E. BOULDER ST. COMPANY <br /> LETTER C <br /> COLORADO SPRINGS, Co 80909 <br /> COMPANY D <br /> i LETTER <br /> COVERAGES <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> COPOLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS <br /> • LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM/OD/YY) DATE(MM/DO/YY) <br /> GENERAL LIABILITY GENERAL AGGREGATE 'NONE <br /> X COMMERCIAL GENERAL LIABIUTY SSP1340346 12:01 AM 12:01 AM PRODUCTS-COMP/OPS AGGREGATE S 1000 <br /> A JCL IMS MADE n OCCUR. 1-19-93 1-20-93 PERSONALS ADVERTISING INJURY S'1 1000 <br /> OWNER'S&CONTRACTOR'S PROT. 7 EACH OCCURRENCE f 1000 <br /> N • FIRE DAMAGE(Any one rue) S 50 <br /> MEDICAL EXPENSE(Any one person) S 5 <br /> ' PARTICIPANT LEGAL LIABIUTY - '1000 <br /> AUTOMOBILE LIABILITY COMBINED <br /> SINGLE S <br /> ANY AUTO LIMIT <br /> ALL OWNED AUTOS BODILY <br /> INJURY f <br /> .SCHEDULED M rTf`^ (Per person) <br /> HIRED AUTOS BODILY <br /> INJURY S <br /> NON-OWNED AUTOS (Per accident) <br /> GARAGE LIABILITY PROPERTY S <br /> DAMAGE • <br /> EACH AGGREGATE <br /> EXCESS LIABILITY OCCURRENCE <br /> S S <br /> OTHER THAN UMBRELLA FORM • <br /> STATUTORY <br /> WORKER'S COMPENSATION <br /> f (EACH ACCIDENT) <br /> • <br />_..—. _.. .__.—_. _._ ... AND ._. ,_.. .S - (OISE:SE=FOLIYLIMIT) _ - <br /> EMPLOYERS'LIABILITY • <br /> 5 (DISEASE—EACH EMPLOYEE) <br /> AO&D S <br /> PARTICIPANT PRIMARY MEDICAL S <br /> ACCIDENTEXCESS MEDICAL S <br /> WEEKLY INDEMNITY ti X <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS • <br /> EVENT: AMATEUR BOXING SHOW <br /> LOCATION: BEL RAE BALLROOM • 5394 EDGEWOOD DRIVE MOUNDS VIEW, MN 55112 i <br /> CERTIFICATE HOLDER CANCELLATION <br /> • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> EX AtATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL <br /> U.S. AMATEUR BOXING FEDERATION <br /> U DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br /> ' C/0 UPPER MIDWEST GOLDEN GLOVES . <br /> gUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY <br /> 2316113thAVE NOF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. <br /> COOONN RAPIDS, MN.. 55 33 N <br /> ' AUTHORIZED REPRESENTATIVE ay • <br /> .0 43**44/: I <br /> i <br /> FORM$ SL•39 a 12 <br /> Ay � <br />