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JAN -14 -98 WED 12:19 PM CFG INSURANCE SERVICES FAX Na 612 945 9477 <br />-% { <br />P. 03/09 <br />ONON'P_A8TttWfl WQ Y <br />POUCYHOLngR: j City of Little Canada , • <br />POUCY`NUMRER: 522836 00i —t " <br />POUCY EFFECTIVE DATIEt January 1,1998 <br />POUCY ANNIVERSARY DATE: January 1 <br />GOVERNING JURISDICTION. Minnesota <br />UNUM Life Insurance Company of America (referred to as UNUM) will provide benefits <br />under this policy. UNUM makes this promise subject to all of this policy's provisions, <br />The policyhold should read this oltcy carefully and contact UNUM pprompt y w t a y <br />questions. Thts'polid y is delivsretfin and is governed by the Iaws�Stlffe ming <br />Jurisdiction and to the extent applicable by the Employee Retirement Income ISemurity <br />Act of 1974 (ERISA) and anyameficI ients. This policy consists el , <br />- ail puNcy p isibne and any amendMents and/or\attechments Issued; <br />employ al ed rpplicafons; end <br />Ihe-ueN of coverage, <br />This policy may be changed In whole or In part. Only an officer or a registrar of UNUM <br />can approve a change, The approval must be In writing and endorsed on or attached <br />to thls policy, No other person, including an agent, may change this policy or waive any <br />part of ft. <br />Signed for UNUM at Portland, Maine on the Policy Motive Date. <br />Boa <br />President • <br />Secrete <br />:UNUM Life tnsuranckh Corn anyaf America <br />PddlaB rive 041$2.'. ._._. <br />Copyright 1989, uNUM Life Insurance Company of America <br />C,FP -i C.FP•1 (1/1f1998) <br />•$NY SAY'S wnNn* xA at❑ : to se 'OT •t o <br />Page 60 <br />