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• <br /> CERTIFICATE OF INSURANCE <br /> This certifies that TATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois <br /> STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois <br /> insures the following policyholder for the erages ind ated below: <br /> Name of policyholder 1 ee i ` O , c f <br /> Address of policyholder 9' 1' ` 7 <br /> kt 6 ? 7 r 2r <br /> Location of operations <br /> POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY <br /> Effective Date ; Expiration Date <br /> ❑ Comprehensive BODILY INJURY <br /> General Liability ❑ Dual Limits for: <br /> ❑ Manufacturers and Each Occurrence $ <br /> Contractors Liability Aggregate $ <br /> ❑ Owners, Landlords, <br /> PROPERTY DAMAGE <br /> and Tenants Liability <br /> Each Occurrence $ <br /> This insurance includes: ❑ Products - Completed Operations Aggregate* <br /> ❑ Owners or Contractors Protective Liability BODILY INJURY AND <br /> ❑ Contractual Liability PROPERTY DAMAGE <br /> ❑ Professional Errors and Omissions ❑ Combined Single Limit for: <br /> ❑ Broad Form Property Damage Each Occurrence <br /> ❑ Broad Form Comprehensive General Liability Aggregate <br /> POLICY PERIOD CONTRACTUAL LIABILITY LIMITS (if different from above) <br /> POLICY NUMBER TYPE OF INSURANCE Effective Date Expiration Date BODILY INJURY <br /> Each Occurrence <br /> PROPERTY DAMAGE <br /> Each Occurrence <br /> Aggregate <br /> EXCESS LIABILI ? BODILY INJURY AND PROPERTY DAMAGE <br /> / �(�� / (O (� (Combined Single Limit) <br /> 3 �5..� ` F mbrella c l Each Occurrence $ <br /> Q t y (� F L Other Aggregate $ <br /> Part 1 STATUTORY <br /> ❑ Workers' Compensation Part 2 BODILY INJURY <br /> and Employers Liability Each Accident $ <br /> Disease Each Employee $ <br /> Disease - Policy Limit $ <br /> 'Aggregate not applicable if Owners, Landlords, and Tenants Liability Insurance excludes <br /> structural alterations, new construction, or demolition. <br /> THIS CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS, OR <br /> ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. <br /> Name and Address of Certificate Holder ?At <br /> • signature of AuttxxizedNve <br /> Title �( <br /> 4 `� D ate <br /> rue) <br /> aosfUl- 610 E ON INS <br /> 192 <br /> F8-994.10 Rev. Rev. &91 Printed In U.S� J -v--t <br /> f ? 7 c(o AG <br /> EN CY INC <br /> ci % FNE1SPRINGFIELD 73 <br />