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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 coverages indicated b Name of policyholder k,e 4) r t belo <br /> C d <br /> Address of policyholder af14 Peel) '(L�t,L. C%_; (Al ----- 0 C C ' <br /> , gD 1/1 — 7 (ss� �, - C 7 y ?r <br /> Location of operations CJ <br /> POLICY PERIOD LIMITS OF LIABILITY <br /> POLICY NUMBER TYPE OF INSURANCE Effective Date ; Expiration / Date <br /> n _Comprehensive <br /> /r rC �y c� �' I �` cf BODILY INJURY <br /> ('7 —EC — ?16 , General Liability 1 l7 o O "`---(ll Dual Limits for: <br /> ❑ Manufacturers and Each Occurrence $ 1 / boo e O <br /> Contractors Liability Aggregate $7 rOQc f 00r <br /> ❑ Owners, Landlords, PROPERTY DAMAGE <br /> and Tenants Liability <br /> Each Occurrence $ <br /> This insurance includes: % Products - Completed Operations Aggregate* <br /> i Owners or Contractors Protective Liability BODILY INJURY AND <br /> :' A ontractual Liability PROPERTY DAMAGE <br /> t /rfrofessional Errors and Omissions ❑ Combined Single Limit for: <br /> Kt Broad Form Property Damage Each Occurrence <br /> n Broad Form Comprehensive General Liability Aggregate <br /> CONTRACTUAL LIABILITY LIMITS (if different from above) <br /> POLICY PERIOD BODILY INJURY <br /> POLICY NUMBER TYPE OF INSURANCE Effective Date ; Expiration Date <br /> Each Occurrence <br /> PROPERTY DAMAGE <br /> Each Occurrence <br /> Aggregate <br /> BODILY INJURY AND PROPERTY DAMAGE <br /> EXCESS LIABILITY (Combined Single Limit) <br /> ❑ Umbrella Each Occurrence $ <br /> ❑ 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 demottion. <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. .••. —` � G � ' <br /> Name and Address of Certificate Holder I -J , 4/ <br /> Signature of Authorizeg esentat <br /> C ;( -L IA cE6A-i R:M Tale <br /> ,�k �'`— 1 Z3(f Y <br /> ` , � ev ate <br /> j 2-a Agen ITON INS <br /> . -- 7 0 . AGENCY It A/C 1927 <br /> F..99410 Rev. 6-91 Prated in U. ! <br /> Pi IPPMPfcr s ira.3rPM n F41.7,S <br />