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ACORD,.
<br />
<br />PRODUCER SE[)G!.'J.[CK ..)Ai"'i(i!15
<br /> r._lF iLL. INOIS., ii'JO,
<br /> 2:-~A NEc, I MOI',iF~OE STREET
<br /> CHICAGO, IL 6O&O&'-' 4998
<br /> ATTN: SHIRLEY 7'SE
<br />
<br />INSURED
<br />
<br /> DATE (MM/DD/YY)
<br />CERTIFICATE OF LIABILITY INSURANCE
<br /> THIS CERTIFICATE IS ISSUED AS A MA3'I'ER OF INFORMATION
<br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br /> COMPANIES AFFORDING COVERAGE
<br />
<br /> COMPANY
<br /> A Nat,~ona] UnSo'n Fi. re Ins, Co,
<br />
<br />AMOCO OIL. CO/PE'TR[]I.EUM PROD.
<br />SUBf-;J[[~:CARY (~I AI't(I(:II (:(II~I'(~RA'I
<br />A'fTN ELAINE HERRMANN
<br />~00 E RANDOLPI4 MAIL CODE 3~01
<br />~iICAGO :IL 60601-6401
<br />
<br />COMPANY
<br />B Illinois Na'bio'nal Ins. Co.
<br />
<br />COMPANY
<br /> ¢
<br />
<br />COMPANY
<br />
<br />COVERAGES
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />
<br />TYPE OFINSURANCE
<br />
<br /> GENERAL UABIUT~
<br />
<br /> COMMERCIAL GENERAL LJA~UTY
<br />
<br />__ CLAIMS MADE j J OCCUR
<br /> OWNER'S & CONTRACTOR~ PROT
<br />
<br />AUTOMOBILE LIABILITY
<br />
<br /> ANY AUTO
<br />
<br /> ALL OWNED AUTOS
<br />
<br /> SCHEDULED AUTOS
<br />
<br /> HIRED AUTOS
<br />
<br /> NON-OWNEO AUTOS
<br />
<br />GARAGE UABILITY
<br /> ANY AUTO
<br />
<br />EXCESS UABIUTM
<br /> UMBREM..A FORM
<br />
<br /> OTHER THAN UMBRELLA FORM
<br />
<br />POLICY HUMBER
<br />
<br />Gl_ 565314 9RA
<br />
<br />SSFt.F INSURED ].N:
<br /> DE, IL, IN, KS,
<br /> hiD, MI.<, TX,, UT,.
<br />
<br />WC56540J;ZRA (.[1_)
<br />WCSL-549;I. IRA (DOME
<br />WC5654013RA (MA,MX
<br />(WC555401.4 (OTHER S
<br />
<br /> I ,.-.60,~87 ~
<br />3 ONLY )
<br />
<br />~OLI¢¥ EFFECTIVE
<br />DATE (UM/DD/YY)
<br />
<br />2./0I/97
<br />
<br /> 1P_I01197
<br />~R, CO, C:
<br />.A. b'iN. M
<br />4A, WZ
<br />
<br />1P_/01/97
<br />'E I RC)LEUM
<br />
<br />P, TES: XS
<br />
<br />1~/01/97
<br />
<br /> WORKERS COMPENSATION AND
<br /> EMPLOYERS' UABILITY
<br />
<br /> THE PROPRIETOR/ r-~ INcL
<br /> PARTNERS/EXECUTIVE
<br /> OFRCERS ARE: EXCL
<br />A-J OTHER
<br />I PROPffRI"Y
<br /> (LEASED LI]CATZON
<br />
<br />POUCY EXPIRATION
<br />DATE (MM/OD/W)
<br />
<br /> J P./O 1/~
<br />
<br />1 ~_~ / 0 .l
<br />
<br />, NY
<br />
<br />12101/98
<br />
<br />BII:~ )
<br />
<br />12_10t1'78
<br />
<br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPEC[AL ITEMS
<br /> FZVIDENCE OF- Gl_ COVE. RA(~E RE: BEER LICENSE FOR
<br /> AVE, N,W, RAFSE'Y, l'fiN .55303,1_IG. UOR LIAgIt. I:TY
<br />
<br /> UMIT8
<br />
<br /> GENERAL AGGREGATE
<br />
<br /> PRODUCTS . COMR/OP AGO
<br />
<br /> PERSONAL & ADV INJURY
<br />
<br /> EACH OCCURRENCE
<br />
<br /> FIRE DAMAGE (Any one fire)
<br />
<br /> MED EXP (Any one person)
<br />
<br /> COMBINED SINGLE UMI¥
<br />
<br /> BODILY INJURY
<br /> (Per person)
<br />
<br /> BODILY INJURY
<br /> p~r ~,cclden0
<br />
<br />PROPERTY DAMAGE
<br />
<br />AUTO ONLY - EA ACCIDENT
<br />OTHER THAN AUTO ONLY:
<br />
<br /> EACH ACCIDENT
<br />
<br /> AGGREGATE
<br />EACH OCCURRENCE
<br />
<br /> X I wc STATU- I IOTH-
<br /> I ToRy U~IT~ I I ER
<br />
<br />EL EACH ACCIDENT
<br />
<br />EL DISEASE - POUCY UMFr
<br />
<br />EL DISEASE- EA EMPLOYEE
<br />
<br /> EA GCC:
<br /> FLODD AGG:
<br /> O, UAI(E AS(.;:
<br />
<br />AMOCt] ~I..,~67 5195 14.2ND
<br />IS INCLUDE() IN GL. POLICY,
<br />
<br />500000(11
<br />
<br />50000 C:, 0
<br />5ooooo(~
<br />Y)(}O000(:~
<br />
<br />50000C)0
<br />
<br />.) () (.)
<br />
<br />%00000C
<br />
<br />, I
<br />
<br />s I
<br />
<br />$ lO0000C
<br /> 100000(
<br />
<br />lO0000C
<br />
<br />5000000
<br />5000000
<br />5000000
<br />
<br /> CANCELLATION
<br />r' h; ,?. ~ -~ ,-, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br /> I'~ J EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
<br /> ~,-~4k~AYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
<br /> BUT FAJLURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBMGATION OR UABILITY
<br /> OF ANY KIND UPON THE COMPffY. iTS AGENTS OR REPRESEN ATIVE$.
<br /> AUTHORIZED REPRESENTATIVE
<br />
<br /> ~--; R~ ,.,,.,,,r~,~ATION 1988
<br />
<br />CERTIFICATE HOLDER
<br />
<br />
<br />
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