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Illinois BUSINESSOWNERS <br />Casualty POLICY DECLARATIONS <br />Company <br />A Mutual insurance Company Be DEC IC 01 10 <br />225 20a Street, Rock Island, IL 61201 • (309) 793-1700 ♦ (8001 445.3720 • Fax: (309) 793.1707 • www.ilcasco.com <br />These Declarations, together with the Common Policy Conditions, the Coverage Forms and any applicable endorsements attached thereto, complete the <br />below numbered policy: <br />NO. BP38698 <br />Name and Mailing Address of Named Insured: <br />Name and Mailing Address of Agent/Producer: <br />Vegetable Buddies Inc DBA Vegetable Buddies <br />PO Box 1202 <br />South Bend, IN 46624 <br />08030 <br />Randy Leliaert Agency, Inc. <br />410 Lincolnway West <br />Osceola, IN 46561 <br />(574)674-0016 <br />POLICY PERIOD <br />From: 04126.12016 12:01 AM <br />To: 04/2612017 12:01 AM <br />Standard Time at your mailing address shown above <br />IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, <br />WE AGREE WITH YOU TO <br />PROVIDE THE INSURANCE AS STATED IN THIS POLICY. <br />DESCRIPTION OF BUSINESS <br />Form of Business of the Named Insured: []Individual <br />Partnership El Joint Venture Limited Liability Company <br />Trust <br />© club Ej Organization (Any other) <br />Business Description: Restaurant <br />DESCRIBED PREMISES <br />Prem. No. <br />Physical Location <br />1 <br />129 N Michigan St <br />South Bend, IN 46601 <br />PROPERTY <br />DEDUCTIBLES Property Deductible: $1,000 Optional CoverageslFxterior Building Glass Deductible: $1,000 <br />BP DEC IC 0110 Original Page 1 of 3 <br />