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Date_ <br />1) <br />21 <br />3) <br />4) <br />5) <br />6) <br />7) <br />8) <br />9) <br />0) <br />1) <br />2) <br />3) <br />CITY OF MOUNDS VIEW, MINNESOTA <br />Coverage <br />Property <br />Valuable Papers & Records <br />Extra Eypense <br />inland Marine <br />Boiler & Machinery <br />Comprehensive General Liability <br />Comprehensive Automobile <br />(a) Liability <br />(b) Comprehensive <br />(c) Collision <br />Crime <br />Depositors Forgery <br />Bonds <br />Umbrella Liability <br />Workers' Compensation <br />Pvhlic officials' Liability <br />1NSIIRAN_ C� 1L <br />May 1, 1984-1985 <br />Insurance Company <br />One Year Net Premium Cost - Items 1 - 13 <br />Please attach addendum identifying alternative cost quotations. <br />Thirty day notice of cancellation or non -renewal required. <br />Annual Premium <br />CERTIFICATION <br />I, the undersigned, certify that we lmve met all the requirements of the specifications except <br />those identified by the attached addendum. <br />Agency Signature <br />71 <br />