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! ~ C 0 R D I N <br /> ' THIS BINDER IS <br /> <br />I !PRODUCER ICOMPANY Oper, ID 03 :BINDER NO. <br /> i CENTRAL INSURANCE AGENCY <br /> ' COLONIAL MALL, BOX 400 IEFFECTIVE 12:01 AM 07/01/91 <br /> ! ST. MICHAEL MN 55376- IEXPIRES IX] 12:01AM [ ] NOON 07/31/91 <br />m , I[ ] This binder is issued to extend coverage in the above named com~ny <br /> I CODE 040-03813 SUB-CODE <br /> <br />m IINSUREO IOESCRIPTION OF OPERATION/VEHICLES/PROPERTY(INCLUDING LOCATION) <br /> I Ramsey Lions Club I FIDELITY BOND <br /> ,' P.O. Box 771 <br /> Ramsey MN 55303 <br />mI Hamlet <br /> ATTN: <br /> Jerry <br />IC 0 V E R A G E S ............................................... ALL LIABILITY LIMITS 1N THOUSANDS ............................ <br />m !TYPE OF INSURANCE ICOVERAGES/FORMS AMOUNT DEDUCTIBLE ICOINS <br /> <br /> ',PROPERTY CAUSES OF LOSS <br />m [3 BASIC [ ] BROAD [ ] SPECIAL <br /> [3 <br /> [3 <br /> <br /> GENERAL LIABILITY I IGENERAL AGGREGATE $10 <br /> [) COMMERCIAL GENERAL LIABILITY ', IiPRODUCTS-COMP/OPS AGGREGATE <br />m[][ ] CLAIMS MADE [ ) OCCURRENCE ', I, PERSONAL& ADVERTISING INJURY <br /> ' ',EACH OCCURRENCE <br /> [ I OWNER'S & CONTRACTORS PROTECTIVE , <br /> [X] GAMBLING MANAGER BOND ',RETRO DATE FOR CLAIMS MADE I, FIRE DAMAGE (ANY ONE FIRE) <br />m[) ,, / / ',MEDICAL EXPENSE(ANY ONE PERSON) <br /> 'AUTOMOBILE ', [ ] ALL VEHICLES ',CSL <br /> [! LIABILITY : [ ] SCHEDULED VEHICLES IBI PERS/ACCID <br />m [] NON/OWNED ', '~PD <br />I ] HIRED ', IMED. PAY <br />[) GARAGE i, i, plp <br />mF 1 , <br /> !AUTO PHYSICAL DAMAGE ', [ ] ALL VEHICLES i, [ ] ACV <br />mI [ ICOLLISION OEO: [ )OTC DED: ', [ ) SCHEDULED VEHICLES i. [ 3 STATED AMOUNT [ )OTHER <br /> '.EXCESS LIABILITY ': ',EACH OCCURRENCE <br /> I [ ! UMBRELLA FORH ',RETRO DATE FOR CLAIMS MADE IAGGREGATE <br />m ,= [ ] OTHER THAN UMBRELLA FORM ', ',SELF-INSURED RETENTION <br /> I ...................................................................... Statutory .................................................. <br /> ',~ORKER'S COMPENSATION & EMPLOYERS' LIABILITY ~, EA ACCIOENT DISEASE-POLICY LMT DISEASE-LA EMPLOYEE <br /> <br /> SPECIAL CONDITIONS/RESTRICTIONS/OTHER COVERAGES <br /> <br />m AiAE AND ADDRESS .................................................................................................. <br /> ',LOAN NUMBER <br /> ) AUTHOR]~I~ED RE~.J~SENT~AjIVE <br />m[ ]MORT [ ]LOSSPAYEE [IADDL INS [)MORT [ ]LOSS PAYEE [)ADDL INS 'jj~~.. _ ~'~ <br /> [ 1 ',m'''',~ / <br />· <br /> [] <br />·ACORD 75-S (11/85)====::==:=::==:::==:=====:='-:=:====::=:=== ...... =================================== .... = ......... =::=::~-~::i <br /> <br /> <br />