Laserfiche WebLink
. s <br /> 0 Q11- <br /> LIBERTY <br /> This is to Certify that MUTUAL <br /> I— �enu.im.na a•...,.,mn•o�,p.m•..a m.... <br /> Minneapolis Bowl-O-Mat, Inc. Name and <br /> c/o Fair Lanes, Inc. address of <br /> 1112 North Rolling Road Insured. <br /> Baltimore, MD 21228 I <br /> Liss,, at the date of this certificate, insured by the Company under the poticy(ies) listed below.The insurance afforded by the listed poticy(ies) <br /> is subject to all their terms, exclusions and conditions and is not altered by any requirement, term or condition of any contract or other <br /> document with respect to which this certificate may be issued. <br /> TYPE OF POLICY EXPIRATION DATE POLICY NUMBER LIMITS OF LIABILITY' <br /> COVERAGE AFFORDED UNDER W.C. LAW OF LIMIT OF LIABILITY-COY B <br /> FOLLOWING STATES - (Indicate Limit for each state) <br /> WORKERS' <br /> COMPENSATION <br /> MARITIME COVERAGE FOLLOWING STATES LIMIT OF LIABILITY MARITIME COVER/ <br /> BODILY INJURY PROPERTY DAMAGE <br /> ®COMPREHENSIVE . <br /> FORM EACH EACH <br /> ❑SCHEDULE FORM $ 1,000,000 OCCURRENCE $ 1,000,000 OCCURREt <br /> Q >. ❑ PPRODDCTS CO -OPERATIONS 1,000,000 AGGREGATE $ 1,000,000 AGGREG/ <br /> UJ <br /> Z m 1-1-84 LG1-131-043229-023 <br /> Z Q COMBINED SINGLE LIMIT <br /> Lu INDEPENDENT CON- <br /> J TRACTORS/CONTRAC BODILY INJURY AND PROPERTY DAMAGE <br /> TORS PROTECTIVE <br /> $ EACH OCCURRENCE <br /> ❑CONTRACTUAL $ <br /> LIABILITY AGGREGATE <br /> ❑x Liquor liab lity <br /> >- F-1 OWNED $ EACH PERSON <br /> Q Q NON-OWNED $ EACH ACCIDENT EACH ACCIDE <br /> OR OCCURRENCE $ OR OCCURREr <br /> HIRED $ EACH ACCIDENT-SINGLE LIMIT-B.I.AND P.D.COMBO <br /> W <br /> H <br /> O <br /> LOCATION(S) OF OPERATIONS & JOB # (If-Applicable) DESCRIPTION OF OPERATIONS: <br /> St. Anthony, Minnesota Sales of liquor <br /> Coverage includes $50,000 of loss of means of support of any one person in any one <br /> occurrence, and, subject to the limit for one person, $100,000 for loss of means of <br /> support of two or more persons in any one occurrence. <br /> NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF <br /> DAYS IS ENTERED BELOW). BEFORE THE STATED EXPIRATION DATE THE COMPANY <br /> WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES <br /> UNTIL AT LEAST 30 DAYS NOTICE OF SUCH CANCELLATION OR REDUCTION HAS BEEN <br /> MAILED TO: <br /> City of St. Anthony <br /> Administrative Offices <br /> 3301 Silver Lake Road AUTHORIZED REPRESENTATIVE <br /> Minneapolis, Minnesota 55418 2-23-83 Rockville, MD <br /> L DATE ISSUED OFFICE <br /> This certificate is executed by LIBERTY MUTUAL INSURANCE COMPANY as respects such insurance as is afforded by That Company,It Is aseeut y�IS IRE INSURAF <br /> COMPANY as respects such Insurance as Is afforded by That Company. 8 � � BS 234 RIO <br />