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( 21 Certificate of Insurance <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER <br /> THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW. <br /> NAME AND ADDRESS OF AGENCY <br /> COMPANIES AFFORDING COVERAGES <br /> CORP INSURANCE MGMT <br /> OO WISCONSIN AVE NW LOMPANY A <br /> LETTER <br /> t.� RELIANCE SPECIAL RISK <br /> WASHINGTON DC 20016 <br /> COMPANY <br /> LETTER RELIANCE SPECIAL RISK <br /> NAME AND ADDRESS OF INSURED <br /> COMPANY C <br /> LETTER CIGNA CORPORATION <br /> SPECIAL OLYMPICS INC <br /> 1350 NY AVE N�! ,�00 LOMPANY D <br /> LETTER <br /> WASHINGTON DC 20005 <br /> COMPANY <br /> LETTER <br /> CIGNA This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. t i <br /> con- <br /> dition 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 <br /> all the terms,exclusions and Conditions of such policies. requirement,term or con- <br /> COMPANY TYPE OF INSURANCE <br /> LETTER POLICY NUMBER POLICY ,F Limits of Friability in Thousands(000) <br /> EXPIRATION DATE EACH <br /> A GENERAL LIABILITY OCCURRENCE AGGREGATE <br /> EL0693758 7/01/87 <br /> ©COMPREHENSIVE FORM Inception date 7/01/8f, BODILY INJI,,RY s s <br /> ©PREMISES-OPERATIONS <br /> -EXPLOSION AND COLLAPSE PROPERTY DAMAGE S f <br /> HAZARD <br /> -UNDERGROUND HAZARD <br /> lin PRODUCTS/COMPLETED <br /> OPERATIONS HAZARD <br /> WCONTRACTUAL INSURANCE <br /> BODILY INJURY AND ^ <br /> SI <br /> BROAD FORM PROPERTY PROPERTY DAMAGE S i >'O O O f �, 9 0 0 0 <br /> WDAMAGE COMBINED <br /> INDEPENDENT CONTRACTORS <br /> PERSONAL INJURY 1 PERSONAL INJURY $ 1 7 0 0 0 <br /> E; AUTOMOBILE LIABILITY EB0748091 <br /> -COMPREHENSIVE FORM 7/01/87 BODILY INJURY s <br /> date 7/01/8 IEACHPERSONI <br /> III OWNED BODILY INJURY s <br /> HIRED <br /> 'EACH OCCURRENCE, <br /> PROPERTY DAMAGE S <br /> NONpYYNED <br /> BODILY INJURY AND C <br /> PROPERTY DAMAGE f .J OO <br /> EXCESS LIABILITY COMBINED <br /> 605212674 7/01/87 <br /> WI UMBRELLA FORM Inception date 9/01/86 <br /> -OTHER THAN UMBRELLA BODILY INJURY AND = 4'000 t 4,000 <br /> FORM PROPERTY DAMAGE <br /> COMBINED <br /> WORKER'S COMPENSATION <br /> and 5TATU7pRV <br /> EMPLOYER'S LIABILITY <br /> E OTHER JO098615A <br /> $ IEACH ACCIOBNTI . <br /> Inception date 9/Q1/86 7/01/87 Liability $100 <br /> • " IPTION OF OPERAT■ONS/LOCATION4NENICLEB <br /> XEMPLOYEE DISHONESTY - STATE OFFICES <br /> $100000 STATE CHAPTERS $20000 <br /> PLEASE SEE THE ATTACHED <br /> Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing com- <br /> pany will endeavor to mail 10 days written notice to the below named certificate holder, but failure to <br /> mail such notice shall impose no obligation or liability of any kind upon the company. <br /> NAME AND ADDRESS OF CERTIFICATE HOLDER <br /> NORTH CAROLINA SPECIAL OLYMP DATE ISSUED Sept 18 1986 <br /> SOX 30191 <br /> RALEIGH NC27622 1/44 _ . 4 <br /> AU IgRIZEp REPRESENTATIVE <br /> ,, 5-3 HARRY F CUSTIS <br />