CERTIFICATE OF INSURANCE (2)
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SJA.....iE AUTOMOBILE MUTUAL
i.SURANCE COMPANY
- OF COLUMBUS. OHIO
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CERTIFICATE OF INSURANCE
September ~, 1980
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This certifies that the State Automobile Mutual Insurance Company has issued, to the insured named herein, policies of insurance which provide coverage as indicated
below. Such policies are subject to the provisions, conditions and limitations contained therein.
In the event of cancelation of any policy described below in the schedule, the party to whom this certifical~ is issued will be
vided in the policy. Ten nO) days' notice will be given unless otherwise indicated herein:
notified in writing ;~P!~~rE~
Name & Address Of Party To Whom This Certificate Is Issued
5(1' 1'0 1980
Name & Address of Insured
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i.rn
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Business of Insured Fam ()re~+; ATl!::!
Location of Operations or Premises 1\TO""+'h nf' R+~t.jQl "Rn~n ,5Rn, en jQl~"Y't.n:d:lO""J li'1 ()T>; ib
TYPE OF INSURANCE LIMITS OF LIABILITY POLICY EXPIRATION
NUMBER OATE
Workmen's Compensation As provided by law of the State of
lIS Designates Insurance Afforded or Hazard $ EACH OCCURRENCE*
Excluded) Bodily Injury Liability and $ AGGREGATE*
o Multr.Penl Property Damage liability *70tal Limit for Bodily Injury and Prop-
erty Damage Liability combmed
Excluding Completed
L IXI ComprehenSive } 0 Operations and
G I
EA General Liability Products Liability $ 100 000. EACH OCCURRENCE
NB o Owners', Landlords' and Tenants' liability Bodily Injury Liability $ 500 000. AGGREGATE CIP 119 01 9-20-81
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RL o Excluding Structural Alterations
AI o Manufacturers' and Contractors' Liability
L T o Excluding Independent Contractors Property Damage $ 100000.
Y EACH OCCURRENCE
o Contractual Liability Liability $ 100 000. AGGREGATE
o Completed Operations and Products liability
A L o Comprehensive Automobile Liability Bodily Injury Liability $ EACH PERSON
U I o Basic Automobile liability $ EACH OCCURRENCE
TA Properly Damage Liability $ EACH OCCURRENCE
OB Automobile(s) Specified Below $ EACH PERSON
M, Bodily Injury liability
OL $ EACH OCCURRENCE
BI Property Damage Liability $ EACH OCCURRENCE
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AUTO Automobile(sl Specified Below
P Enc,umbrance-Loss is payable as interest may appear to the IACV=Actuat Cash Value)
HO named insured and: (See reverse side) Car No. Comprehensive Collision Fire Thett
VA $ Deductible $ $ $ $
SM loss Payee-Name $
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C G Address
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S Car No. Year of Model Trade Name Body Type Serial, Motor or Identification No.
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T'(,,'J'ng ~l1n r.nm~~ny, Inc.
Authorize Representative
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