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BOA SECIRA i NSLFRPk I. ' iCE KEEP THIS COPY FCR (C;:3 .._ . C. <br />etc::.,sc:•: : -: 2.c ri ' t.:Z:1.1161 CONTINUATION CERTIFICATE AND PREMIUM Nor:cE <br />Continuation Clause: if you pay the premium due on or before the due date we will renew the policy described in this <br />certificate. All provisions of your policy and any endorsements will apply. The nonpayment clause on the back of this <br />certificate also applies. If any new forms or endorsements apply, they will be enclosed <br />with this certificate. POLICY PERIOD: <br />POLICY NUMBER FROM 12:01 A.M. 05 -27 -96 <br />HP 214 65 40 = _.— en:s :aze -ace TO 12:01 A.M. 11 -27 -96 <br />:Named :yiencer ease checar -- LEGAL TIME <br />:ereacd;end:ms 1 <br />muted :mice o mccga,ee I_ <br />HALL LARRY <br />881 E COUNTY RD E <br />WHITE <br />BE MN 551TQ- <br />7 /cc' .L -c _737 <br />PH 612- 773 -5393 AGENCY 220676— —1 <br />STAR INS AGY OF <br />WHITE BEAR LK INC <br />2682 E CTY RD E <br />WHITE BEAR LK MN 55110 <br />INSURANCE IS PROVIDED ONLY IF THESE DECLARATIONS SHOW <br />A PREMIUM OR A LIMIT OF LIABILITY FOR THE COVERAGE. <br />COVERAGES /LIMITS OF LIABILITY RES #1 <br />DWELLING <br />OTHER STRUCTURES <br />PERSONAL PROPERTY <br />LOSS OF USE <br />PERSONAL LIAB —EACH OCCURRENCE <br />MED PAY TO OTHERS —EACH PERSON <br />125/000 <br />12,500 <br />87,500 <br />50/000 <br />300,000 <br />5,000 <br />33.3 <br />TOTAL DUE <br />$223.80 <br />RES #1 —BASIC 183.80 <br />DEDUCTIBLE APPLICABLE: SECTION I ALL PERILS $250 <br />SCHEDULED PERSONAL PROPERTY: (SEE SCHEDULES FOR DETAILS) <br />JEWELRY... $1,415 GUNS $805 SCHEDULED PROPERTY 14.50 <br />OPTIONS & FORMS APPLICABLE: (FORMS THAT HAVE BEEN REVISED ARE ATTACHED) <br />RES #1 — PROTECTOR PLUS PKG INCL <br />OPTION 1 —INFL GUARD— 5.2% <br />OPTION 3— REFRIG PRODUCTS <br />OPTION 6— COMBINED STRUC COVG <br />OPTION 8— COLLAPSE <br />OPTION 10 —PERS INJ <br />HPP -03 8606 HOME PROT POL —SPEC <br />H0E704 9005 AMEND POL PROVISION <br />HOE677 9309 LOCK REPLACE ENDT <br />HOS700 8704 SUPPLEMENTAL DECL. <br />OOPTIION 2/3/4/718/9.10/24 2PEfSPRO FORM HOE 677 <br />REEPL COST <br />OPTION 4— TRANSIT <br />OPTION 7— DEBRIS REMOV <br />OPTION 9— LANDSLIDE <br />OPTION 24 —REPL COST PROT <br />HOE61 8611 SCHED PERS PROPERTY <br />HOE706 9107 MINN AMEND ENDT <br />ILE466 9512 LEAD /ASBESTOSSE#CLADDL <br />25.50 <br />>»» TOTAL PREMIUM DUE $223.80 <br />PREMIUM BASED ON: <br />2% SMOKE ALRM CRC —RES 1 NO WOOD STOVE IN RES 1 <br />04 -16 -96 H0777 <br />MN <br />Page 55 <br />ER :LS CNTY GRP CONST FAM BLT UPGRD HYD ML5 ROOF SITE /AL <br />i5 33 62 15 FRAME 1 79 500 1 AP <br />