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me <br />UAAII AND ADDRESS of AI:LNCY <br />Nor•I,h bl„•1,;,,, Al;cncir.:;, Inc. <br />INSURANCE SUIVICE CI N I I.It <br />2601 COON RAPIDS It0(IL1VARD <br />COON RAPIDS, MINNLSO'IA 55433 <br />.1All n LJiG il)tiS of INSUINIU— <br />�14`Rti Inc, <br />-Fndnr!.e:.Enterprisgs,. , <br />C/U raul & Jurdoil Fudor <br />5491 Adams Street <br />bloundsview, MN* 55112 / ! /J ,4r <br />Typo and Location or Property <br />P <br />R <br />0 <br />P <br />E <br />It <br />T <br />Y <br />Type or Insurance <br />L 0 Comprehensive Form <br />I n Scheduled Form <br />A I 0 Premises/Operations <br />8 ❑ PfodUC15/Completed Operations <br />I ❑ Contractual <br />L Li um• LiDbilil.y <br />I m Other (speedy below) Q Pr <br />T e^ $ e<m <br />0 Med. Pay. S pane A,c <br />Y OPersonal Injury _— _---- — <br />�ed' 0 Liability 0 Non-own❑Hired <br />T OComprehenswe-Deductible $ <br />0 LJ Collislon.Deduchblc $ <br />0 0 Medical Payments <br />8 I L]Uninsured Motorist $ <br />I n No fault (specify): <br />L j 0 Other (specify): <br />I <br />l <br />— Statutory Limits (specify staes <br />CI WORKERS' COMPENSATION below) <br />162 <br />COMPANY (ol,unlNia CnnunlLy Company <br />March 1, L <br />EllnClwe i.':01 ;inn 19 83 <br />Lppues -12.01 Bill March 30, _`_ <br />r 0 This Under is issued to extend coverage in the above n <br />company per expiring Policy 4 (eapl at wed ql") <br />Description or Operation/Vehicles/Property <br />pram Shop I.i;NbLlity <br />Coverage/Porils/Fo-- rm� _ Aml of Imurann Ded. <br />Coverage/Forms <br />A ❑8 0C <br />Injury $ <br />ty <br />le � <br />Injury & <br />ly Damage <br />nbined <br />Personal Injury <br />...1-1 .-- <br />Injury (Each Occurrence) $ <br />Damage $ <br />Injury 8 Properly Damage <br />Combined $ <br />0 EMPLOYERS' LIABILITY — Limit $ <br />SPECIALCONDITIONS/OTHER COVERAGES Injury each person <br />LigLEor Liability — Limits: $lU0 000 Bodily injury each common cause <br />$100,000 Property Damage each ns of oruse <br />tmon each acommon cause <br />$100,000 Loss of tint) nno Loss of Means of Support aggregate <br />MDN1GAOLE <br />❑ LOSS PAYEE [3 ADD L INSURED <br />.AAII. AND ADDRESS W O <br />LOAN tiuAIULN <br />b ed Representative ve Date <br />Jy'vlalLire of Authoet <br />.. <br />Authorized by John H. Crowther, Inc. <br />