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So I ' "7 5 _ O. • — ISSUE DATE(MM/Dp/YY) • , <br /> CERTIFICATE OF INSURANCE /`3I9? <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 A • <br /> LETTER • TR ANSAMER TC.A TNq COMPANY <br /> INSURED , <br /> TI.SA AMATEUR BOXING FEDERATION COMPANYR B <br /> • UPPER MIDWEST GOLDEN GLOVES <br /> 1750 E. BOULDER ST. LETTER C • <br /> COLORADO SPRINGS, CO 80909 • <br /> COMPANY D <br /> 1 LETTER <br /> • <br /> COVERAGES10 THE INSURED NAMED ABVE FOR THE POLICY PERIOD <br /> INDICATED.THIS IS TO CERTIFY THAT THE POES F <br /> (REQUIREMENT.TERM OR CONDITION OF ANY CO NCE LISTED BELOW HAVE BEEN ISSUED TRACT OR OTHER DOCUMENT WIDTH RESPECT TO WHICH THIS <br /> . •: . ► HE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN'•' ''' : , - ..- a a • - <br /> ' IC.T°R TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION <br /> ALL LIMITS IN THOUSANDS <br /> DATE(MM/ODAYY) DATE(MWDOTYY) <br /> GENERAL AGGREGATE f NONE <br /> GENERAL LIABILITY • <br /> • , r PRODUCTS•COMPIOPS AGGREGATE S 1000 <br /> A <br /> COMMERCIAL • •2 '1.1/22/92 PERSONAL&ADVERTISING INJURY S 1000 <br /> EACH OCCURRENCE i <br /> OWNER'S 1 CONTRACTOR'S PROT. <br /> FIRE DAMAGE(Any one I'r.) i 50 <br /> MEDICAL EXPENSE(Any one stew) S 5 <br /> PARTICIPANT LEGAL LIABIUTY • S 1000 <br /> COMBINED <br /> . AUTOMOBILE LIABILITY <br /> SINGLE S <br /> LIMIT <br /> ANY AUTO <br /> BODILY <br /> AUTOSALL OWNED <br /> INJURY S <br /> (Per person) •• _ , <br /> BODILY <br /> ' HIRED AUTOS <br /> INJURY S <br /> . NON-OWNED AUTOS (Per accident) <br /> GARAGE LIABILITY .- PROPERTY S <br /> DAMAGE • <br /> • <br /> EACH AGGREGATE <br /> EXCESS LIABILITY <br /> OTHER THAN <br /> OCCURRENCE <br /> • <br /> S f <br /> UMBRELL �. <br /> STATUTORY <br /> S (EACH ACCIDENT) <br /> • (DISEAiE=POLIC(LIMIT) -'"' <br /> 0 (DISEASE—EACH EMPLOYEE) <br /> ADSD S <br /> • PRIM�YA MEDICAL --i <br /> PARTICIPANT <br /> EXCESS MEDICAL S <br /> ACCIDENT <br /> WEEKLY INDEMNITY f X • <br /> DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS <br /> EVENT; AMATEUR BOXING SHOW I <br /> LOCATION; BEL RAE BALLROOM 5.394 EDGEWOOD DRIVE, MOUNDS VIEW, MN. • <br /> CERTIFICATE HOLDER CANCELLATION . <br /> • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> EX ATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL' • <br /> U.S. AMATEUR BOXING FEDERATION DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br /> • l0 UPPER MIDWEST GOLDEN GLOVES , <br /> BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY <br /> 2 316 113th. AVE NW. OF ANY KIND UPON THE COMPANY.ITS AGENTS OR REPRESENTATIVES. 1 <br /> COON RAPIDS, MN. 55G 33 AUTHORIZED REPRESENTATIVE �'L//���// <br /> 4.2...de <br />• I:0.4 <br /> PORIA i SL 32 -----— ----- I ---- — — — <br />