|
<br />
<br />'': ~1.
<br />
<br />
<br />--- --,-:--:-::--------- ----------- ---.~.----... --.........,;...,.. ---" ,"
<br />~~~~~~~~~~~0~~~~~~e~~i~;.];7t-.:::~~~j,,~;fj}....~~:-~=--"';:.;li,.;;:~:-'i:'!:::-~'E~:=;k.:, -
<br />
<br />. .
<br />
<br />n,
<br />
<br /> ------ .--.----~--_.--- . . .'I.~r. n ....;~..._.;...-.i~.;;;;,;... ....;..i...""-;...~;'-i:i-:...""'- .- _ .--_-c~,_p -:-~. ::'~.'-::-_ ::::'!:; "I. :".1':_"'''- ~"_. ". " ...-.." - ... .. .... .
<br /> __ _ _._ . ______ __ .."'P'........v COIlllPANY
<br /> - --... -...-----..- ..---.-. -
<br /> I LARAMIE INSURANCE COMPAIOI
<br /> KEN STRUM INS. AGENCY, INC. Effective 12:01 AM 10/29 ,19 88
<br /> P.o. BOX 1459 Expires KJ 12:01 am D Noon 10/30.19 88
<br /> LA PORTE, TX. 77572 D This binder is issued to extend coverage in the above named
<br /> company per expiring policy # - ---
<br /> (except as noted below) ___ ._n
<br /> - -... -- -.. --.. _ -- ..._.._-- Description of Operation/Vehicles/Property --
<br /> - -.. ------- _.~ --.-. .--.. -.-.-..
<br /> - "
<br /> MAIN STREET FAIR ASSOCIATION MAIN STREET FAIR, LA PORTE, TX. ,:.,c
<br /> LA PORTE, TX. 77571 ONE DAY ONLY EVENT - EXHIBITIONS
<br />----
<br />j Type and Location of Property Coverage/Perils/ Forms Amt of Insurance Ded. Coins,
<br /> %
<br />.....
<br />'1
<br />J p
<br />"/ R
<br />0
<br />. . ~.l: .1 p
<br />...., E
<br />R
<br />T
<br />,>1 Y
<br />.- ;:.;
<br />-- ::>, ~ .
<br />,__i..,!
<br />',::,:i
<br />"'1 Type of Insurance Coverage/ Forms Limits of liability
<br />. .;., Each Occurrence Aggregate
<br />',I L D U Comprehensive Form Bodily Injury $1,000,00 .,~
<br />I Scheduled Form p
<br />A D Premises/Operations 1,000,00
<br />B
<br /> I D Products/Completed Operations Property Damage $ $
<br />:;;;.' L D Bodily Injury &
<br /> I Contractual
<br /> T 6U Other (specify below) * Property Damage $ $
<br /> Y D Combined
<br /> Med. Pay, $ Per $ Per
<br /> D Person Accident D D Dc Personal Injury $ ..
<br /> personal Injury A B ,,'~
<br /> Limits 01 Liability ..~~
<br /> A, D Liability D Non,owned D Hired Bodily Injury (Each Person) $ -
<br /> U .~
<br /> T D Com prehensive-Deducti ble $ Bodily Injury (Each Accident) $
<br /> 0 D Collision-Deductible $ I Property Damage
<br /> M -~-
<br /> 0 D Medical Payments $ $
<br />- B D - . ~
<br /> I Uninsured Motorist $
<br /> L D No Fault (specify): Bodily Injury & Property Damage - --
<br /> E D
<br /> Other (specify): Combined $
<br /> ----- ---
<br />
<br />D WORKERS' COMPENSATION - Statutory Limits (specify states below)
<br />
<br />D EMPLOYERS' LIABILITY - Limit
<br />
<br />$
<br />
<br />r.nN nlTlnN~/nTH FR CQvERAGES
<br />
<br />*
<br />
<br />LIQUOR LIABILITY - $500,000 LIMIT OF LIABILITY
<br />
<br />. ::.~::~- ;:-__-=.......:~-.:':O~~~~"':-;-~~~~-,c,:;!li:..;-~...;;-.::---:-::.-.--:.: ~.. '. .. II
<br />
<br />. :.;;":'.:=-'1I~-rr:::.~~~'i::""-;" ,..x,"j"-:.";
<br />
<br />= - -:" -"~-:-':-::':: _~u- 0 MORTGAGEE
<br />
<br />D LOSSPAYEE
<br />
<br />[lADD'L INSURED
<br />
<br />1\ CITY OF LAPORTE, LA PORTE, T~.
<br />
<br />LOAN NUMBER
<br />
<br />
<br />. AGENCY, II~C .
<br />
<br />JI JESSE T. GARCIA DBA LAS HADAS MEXICAN
<br />RESTAURANT
<br />
<br />,
<br />Signature of Authorized Representative
<br />
<br />10/~ti188
<br />
|