HomeMy WebLinkAbout84- Beall Park Arts Center Insurance Binder
NAME AND ADDHI:SS OF AGENCY US
, E
W A Ire;; ": fo Effective I Z :01 f'm F"elS ~q
13 0)(. 430 Expires 0 12:01 am o Noon , 19
BOcemtarJ mT 5t11/,5 o This binder is issued to extend coverage in the above named
company per expiring policy #-
(except "' noted below I
NAME AND MAILING ADDRESS OF INSURED /N~. Description of Operation/Vehicles/Property
Bee-II PfJl2k, {Jar {leNT€R-
130'f '7 (7 rn-r '5?l 1111- 0111
Boee /Yl flJ IJ
{lo 12~€:-
Coverage/ Perils/ Forms AmI of Insurance Oed. Coins,
%
Nil .---.. --~-- ~.,--
73c:-c;:.1I P IJ Ie- I< B f.,uld 11J1 ~ooo
73US1NeS.S. pe-es.ol\lllL- p/2eJ~lZry fJll/'CIS/-( ICo
7!e IOtUq f tJq 10 -rIM INr;.I,(/!:.t"C!
I I
I
Type of Insurance Coverage/Forms limits of Liabilit
-~_. Each Occurrence
o Scheduled Form p(Comprehensive Form Bodily Injury $ $
o Premises/Operations Property
o Products/Completed Operations Damage $ $
o Contractual ~M~~"~~_~~..
Bodily Injury &
o Other (specify below) Property Damage
[J Med" Pay, $/000 P:'~~)n $10 000 Per Combined ~WO
, AC:CI(Jerl!
'1Personal Injury , OA DB DC Personal Injury
limits of Liabilit
o Liability o Non owned o Hired Bodily Injury (Each Person)
o ComprehenSive-Deductible $ ~BUtJiIY Irljury (Each Accident) $
o Collision-Deductible $ r~.,~_,,~.. .,.~,__. ______. n____"_____
o Medical Payments $ Property Damage $
o Uninsured Motorist $
o No Fault (specify): Bodily Injury & Property Damage
o Other (specify) Combined $
o WORKERS' COMPENSATION - Statutory Limits (specify states below) o EMPLOYERS' LIABILITY - Limit $
SPECIAL CONDITIONS/OTHER COVERAGES
{!/TY OF' ~02efl}~rJ S lri ta- L '- t5e ~DD/TIOlJflL N{JmD I A.J ~' u tUo{ Its 1& Sr:ec.' rs.
13&61/1 Pfdt2k. 7! IA I I cI "'J~ LO(' (~noJ
NAM[ AND ADDR[SS O[ 0 MORH;AGI:I: o LOSS PAYEE o ADDl INSURE.D
LOAN NUMBER