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XXXXX[client to clarify] CERTIFICATE OF INSURANCE ISSUE DATE(MM/DD/YY)
/ / 1/13/98
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PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOMRATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,
Near North Ins Brokerage, Inc. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
000 Xxxxx Xxxxxxxx Xxxxxx ___________________________________________________________________________________
Suites 18, 19, & 20 COMPANIES AFFORDING COVERAGE
Chicago, IL 60611 ___________________________________________________________________________________
SLO COMPANY
CODE SUBCODE 104362 LETTER A Reliance Surety Company
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Xxxxxx X. Xxxxx (000) 000-0000 COMPANY
_____________________________________________LETTER B
INSURED ___________________________________________________________________________________
COMPANY
ALLSTATE LETTER C
3075 Xxxxxxx Xx. So. Plaza H2A ___________________________________________________________________________________
Northbrook, IL 60062 COMPANY
LETTER D
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COMPANY
LETTER E
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COVERAGES
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THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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CO
LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS
DATE(MM/DD/YY) DATE(MM/DD/YY) -------------
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GENERAL LIABILITY GENERAL AGGREGATE $
__ COMMERCIAL GENERAL LIABILITY ____________________________________________
__ CLAIMS MADE __OCCUR. PRODUCTS-COMP/OPS AGGREGATE $
__ OWNER'S & CONTRACTOR'S PROT. ____________________________________________
__ __________________________ PERSONAL & ADVERTISING INJURY $
____________________________________________
EACH OCCURRENCE $
____________________________________________
FIRE DAMAGE (Any one fire) $
____________________________________________
MEDICAL EXPENSE (Any one person)$
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AUTOMOBILE LIABILITY COMBINED
__ ANY AUTO SINGLE $
__ ALL OWNED AUTOS LIMIT
__ SCHEDULED AUTOS _________________________________
__ HIRED AUTOS BODILY
__ NON-OWNED AUTOS INJURY $
__ GARAGE LIABILITY (Per Person)
__ _________________________________
BODILY
INJURY $
(Per Accident)
_________________________________
PROPERTY
DAMAGE $
________________________________________________________________________________________________________________________
EXCESS LIABILITY EACH AGGREGATE
___ OCCURRENCE
___ OTHER THAN UMBRELLAFORM $ $
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WORKER'S COMPENSATION STATUTORY
AND $ (EACH ACCIDENT)
EMPLOYERS' LIABILITY $ (DISEASE-POLICY LIMIT)
$ (DISEASE-EACH EMPLOYEE)
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OTHER
A Form 25
Financial
Institution B2710270 12/01/97 12/01/98 $5,000,000 Limit
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DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS
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CERTIFICATE HOLDER 00001 CANCELLATION
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Lincoln Benefit Life Company EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
134 South 13th MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
Lincoln, NE 68508 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
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AUTHORIZED REPRESENTATIVE
/s/ Xxxxxxx Xxxxx
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XXXXX 25-S (3/88) XXXXX CORPORATION 1988
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