New Search
12/23 '98 13 23 I D : STATE FARM - LAWTON INS . FAX :541 -485 -4326 PAGE 3 <br /> CERTIFICATE OF INSURANCE <br /> This certifies that TATE FARM FIRE AND CASUALTY COMPANY, Bloominylurt, Illinois <br /> LJ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois <br /> insures the following policyholder for the cove ges Indic od bello n I / <br /> Name of policyholder _.. �� t ` di a,„ I�GY r /C _.. <br /> Address of policyholder —. 6.7 5/7 n -2_1..* —_. .. _... _ <br /> uz. ,, n 2- ' 7'f 78. - J 7-.zZ <br /> I ocation of operations _, <br /> POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY <br /> Effective Date ; Expiration Date <br /> (J Comprehensive <br /> General Liability 11 Dug1 Limits for BODILY INJURY <br /> I] Manufacturers and Each Occurrence <br /> Conlraclurs Liability Aggregate $ .....__— ..... <br /> Owners, Landlords, PROPERTY PAMAGF <br /> and Tenants Liability <br /> Each Occurrence $ <br /> This insurance includes: n Products - Completed Operations Aggregate' <br /> L] Owners or Contractors Protective Liability BODILY INJURY AND <br /> ❑ Contractual Liability PROPERTY DAMAGE <br /> ❑ Professional Erroret and Omissions 11 Combined Single Limit for: <br /> El Broad Form Property Damage Each Occurrence _ <br /> ❑ Broad Form Comprehensive General Liability Aggregate __ . _. <br /> POLICY NUMBER TYPE OF INSURANCE <br /> POLICY PERIOD ' CONTRACTUAL LIABILITY LIMIT S or dilterent from above) <br /> Effective Date : Expiration Date BODILY INJURY <br /> Each Occurrence • .. ._..,_ <br /> ..— - —' PROPERTY DAMAGE <br /> --- Each Occurrence <br /> Aggregate <br /> i nEXCESS LIAR TTY BODILY INJURY AND PROPERTY DAMAGE <br /> 3 7,6 F — Pi 5 ti - "-tit St4 /60(41 q /06 4 (' (Combined Single UmIt) <br /> r K Umbrella !� t Each Occurrence $ _. L 0 00.0_4_419 C..) <br /> Other __ Aggregate $ — . , Op. P . Gt!JGt <br /> - -- Part 1 STATUTORY — <br /> ❑ Workers' Compensation Part 2 BODILY INJURY <br /> and Employers Lability Each Accident $ <br /> Disease Each Employee $ — <br /> Disease - Policy Limit $ — <br /> 'ADP-M11 IY11 11p8:11w d (A1l1o1. 1 NMINWLL. 11ML 11111M\ 1.1*MV k,Nt lW l 1■1:MA,1 <br /> 11rub1Y .111 .1,. 11111 Wvootru1tIGR W donnM181. <br /> THIS CERTIFICATE OF INSURANCE is NOT • 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 <br /> /� - �� A l I1 N H1MMVIUH 1 <br /> f / v l : Oc C Vi/ YZ ' / /� . 1 <br /> , j oL (110 e 0461puef MI* <br /> r� t o IL � wP�11'ON INS <br /> c' ? 7dia l- AGENCY INC 1927 <br /> FI W4.1D Roo. 691 Htk000 in Y,e.A. <br /> Fl inFrarmPCiiwr,FIn n F47f4 <br />