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NSU..RA10E - ` >:''
<br /> ',•'::'r. P RODUCER
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
<br /> Bout]ern International I��`r I NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AMEND,
<br /> . . 1 ou u East White St. + EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES B O .
<br /> ;.- Rock Rill, South Carolina 29730 I — -----_-�
<br /> COMPANIES AFFORDING COVERAGE
<br /> LETTER SC7Lit
<br /> �< INSURED - -.�� COMPANY g ��` `
<br /> LETTER CIGNA
<br /> 1, ' N.C. SPECIAL OLYMPICS ' COMPANY `.���-��� — ...�--.-..__,
<br /> 4 P.O. BOX 30191 ; LE TIER C
<br /> Ralef . .. „ .. _, Y.
<br /> c�h, NC 27622 _
<br /> rbrlPa�Y D
<br /> uM1:
<br /> LETTER _•{.
<br /> ,k:_: SOU TH ERM INTERNATIONAL - ce,m.A::v -.�-_�.,�-- --._.-_•-- —-..-----__.
<br /> ;.'+;`. .J . _ -r.. ....-f'k`-'' 7 `-)-,:eFAY-':��t'•ik w ., .rki1 i:.' r*j:; _ _
<br /> _ y-.. • `K... $ _•ii_i.� �C r'- ���� 1::�y„s�i ���J..i!'�'_._•:
<br /> THIS)IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD _
<br /> 1, , NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OH OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY
<br /> BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POE;CIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS,AND CON01-
<br /> - TIONS OF SUCH POLICIES.
<br /> r`=
<br /> .�-�- ter.- -- • �____ _•r
<br /> TYPE OF INSURANCE I �1-.-
<br /> �OLICY NumBER :,.iT,,E I ,' , L;A_iLITY LtmilS I- ''_,
<br /> . ,li
<br /> GENERAL LIABILITY _—_.-.� � „ .a AG,; F.GP*E 7.t.,f
<br /> V COMPREHENSIVE FORM �.�f„l.f
<br /> ■
<br /> P iEMISCS/OPERATlO:.:> I 1pf I C -
<br /> -- i - - -- .. —•.
<br /> ■ UNDERGROUND i i� =
<br /> EXPLOSION&COLLAPSE HAZARD j •r"HOPEgrr i j
<br /> I GAMA sF I I
<br /> - ' ■ PRODUCTS/COMPLETED OPERATIONS L
<br /> •CDNTRACTUAL I GA 8 II
<br /> INDEPENDENT CONTRACTORS RACTORS ' 8 -'� 1 -F.9 " P°
<br /> �. 3i--�i- 1,„,,,B:r•::DI �
<br /> t BROAD FORM PROPERTY DAMAGE Q j 000 ?
<br /> • ! PERSONAL INJURY I �� �'-
<br /> ■
<br /> I PERSONAL INJURY I i I yy _-
<br /> AUTOMOBILE LIABILITY --
<br /> i 300 I ....':
<br /> ANY AUTO I ■
<br /> ALL OWNED AUTOS(PRA' PASS I I i 'X ; ;�
<br /> ALL OWNED AUTOS( 'F.R "RAN I 777T-------1
<br /> HIRED AUTOS Pql`: PASS I -_C�:r:.I S _
<br /> i
<br /> NON-OWNED AUTOS
<br /> GARAGE L ABiLlr, �'f"�F is
<br /> EXCESS LIABILITY -. � ' _�
<br /> ( UMBRELLA FORM I -__�
<br /> OTRER TH UMBRE ' F ..:.1 i- I] I ,
<br /> 'Jr.tnNEG I 's
<br /> WORKERS' COMPENSATION - -... a ...
<br />,...i Ill AND C2 ? 2 - fiiiiEMPLOYERS' LIABILITY LJ I - ' n l ['•-z I OTHER q7� 7 __. ^- l l?,,;; r;'-;!IC,;!;: -...i.
<br /> ADDITIONAL �• wr-
<br /> 11-IURED: North Carol in S al Dillard f�
<br /> .I
<br /> DESCRrRTiON OF OPERATrOrJSiLCcATION r,
<br /> S;VEH!�..ES;SPFoLdi ,7rr!5-- •-—•-- �.._� - - -..- ._-,_._.. - - - '..�,.K
<br />" of iYC•'�` � Dist'iay cite: Chapel P ?i, NC ,..
<br />:a: pet Hill ,i
<br /> 1 Di�s►Y�lay
<br /> /��on:
<br /> � May 13 , 1988 or alternate date
<br /> '•
<br />., -11r. Alan Bolick
<br /> fir
<br /> k _ •K^ :w,:ti �s:�: =
<br /> SHOULD ANY OF THE ABOVE OESSCRIBED PQLIC,r_.;43E CANCELLED BEFORE THE EX- �. .
<br />-,4 P.O. Box J �gl - PIRATION DATE THEREOF, THE IS COMPANY c
<br /> MAIL 1 0 DAYS WRITTEN NOT I .• OMPATE .O D MED T E 24.-•,,;`
<br /> THE CERTIFICATE HOLDER NAMED TO THE
<br /> Raleigh, NC 47521 -: LEFT.BUT FAILURE TO MAIL NOTICE SHALL IMPOSE ',-. •
<br /> a,” OF ANV KIND UPON 7 OSE NO OBLIGATION OP,LIABILITY i(:
<br /> r r16 COMCANY, ITS AGENTS OR REPRESENTATIVcS, ?
<br /> l_- AL:7-1C,�,ZEC REPRE^'F,;TATIVE ----�-••-- •-- .._ -- ---.- . .-. -- ----•
<br /> _. _ y .X. -r .r -.,. fix xy:ti,3
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