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<br /> <br /> ACORD. QCnTIFICAT' ~1 y DATE IMM/DD YYI <br /> 10 29/97 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> AMERICAN INSURANCE AGENCY, INC ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> 900 FORT STREET MALL, STE 500 COMPANIES AFFORDING COVERAGE _ <br /> HONOLULU, HAWAII 96813 COMPANY <br /> (808) 540-3333 FAX: 540-3371 A NATIONAL SURETY CORPORATION _ <br /> INSURED <br /> COMPANY <br /> ROBERT P. HENDERSON DBA: BEAR'S B <br /> COFFEE COMPANY <br /> 106 KEAWE STREET C <br /> HILO, HAWAII 96720 COMPANY <br /> D <br /> CO.(lRAGES <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> CO TYPE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE POLICY EXPIRATION LIMITS <br /> LTR DATE IMM/DD/YYI DATE fMM/DD/YYI <br /> GENERAL LIABILITY GENERAL AGGREGATE s2,000,000 <br /> X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGO a <br /> CLAIMS MADE 191 OCCUR PERSONAL & ADV INJURY $1, 000, 000 <br /> A OWNER'S &CONTRACTOR'S PROT A B5 AZC 80547643 11/01/97 11/01/98 EACH OCCURRENCE $1, 000, 000 <br /> FIRE DAMAGE (Any one fire) $100, 000 <br /> MED EXP Mriy one person) $10, 000 <br /> AUTOMOBILE LIABILITY <br /> ANY AUTO COMBINED SINGLE LIMIT $ <br /> ALL OWNED AUTOS <br /> BODILY INJURY 5 <br /> SCHEDULED AUTOS (Per person) <br /> HIRED AUTOS <br /> BODILY INJURY $ <br /> NON-OWNED AUTOS (Per accident) <br /> PROPERTY DAMAGE $ <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT a <br /> ANY AUTO OTHER THAN AUTO ONLY: <br /> EACH ACCIDENT a <br /> AGGREGATE 5 <br /> EXCESS LIABILITY EACH OCCURRENCE S <br /> UMBRELLA FORM AGGREGATE b <br /> OTHER THAN UMBRELLA FORM $ <br /> WC LIMIT OER - <br /> WORKERS COMPENSATION AND T RY LIMIT ER <br /> EMPLOYERS' LIABILITY <br /> EL EACH ACCIDENT 5 <br /> THE PROPRIETOR/ INCL EL DISEASE- POLICY LIMIT 5 <br /> PARTNERS/EXECUTIVE <br /> OFFICERS ARE: EXCL EL DISEASE- EA EMPLOYEE $ <br /> OTHER <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS <br /> LOCATION: 106 KEAWE STREET, HILO, HAWAII 96720 <br /> THE CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED IN ACCORDANCE WITH <br /> THE GENERAL LIABILITY POLICY PROVISIONS. <br /> CEtt7iFfCATE HbLOER CANCELLiiTIflN <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> COUNTY OF HAWAII EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL <br /> ATTN : MR. NAHULEA 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br /> 25 AUPUNI STREET BUT F, AMRi6ttA"ldA N%Al3&G#,#*O OBLIGATION OR UABIUTY <br /> HILO, HAWAII 96720 OF ANY KIND UPON THE C PANY, ITS AGENTS OR REPRESENTATIVES. <br /> AUTHORIJ&O R <br /> CMIL <br /> ACf1 t0 5-5 it1951 ®ACOR0 CORPORATION 1988 <br /> ethel"Ol gen <br />