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<br />AGENT copy <br /> <br />070522 140355 <br /> <br />p.3 <br />2 ,{ <br /> <br />~~ <br /> <br />Sap 12 07 09:54a TASSA CONSUl TING <br />Sap 12 2007 S:OS FI _ITV INSURANC~ SERVIC <br /> <br />P' ~-444-0012 <br />51G 95145 <br /> <br />DECLARATIONS <br />1"''''ACH 10 YOUR 'OLJC~ <br /> <br />- UN I GARD 1 NSLJ'tANCE CO. <br />p.D-eOX 90701 <br />8fLLEVUE, WI>.. 98009-07<l1 <br /> <br />PQl.H:'V ..._.eft "FEe,.,... c"'''~E'VI' <br />DAn <br />!'>C121328 04/20107 07 / 01/08 <br /> <br />T <br /> <br /> <br />CITY U <br /> <br />1 <br /> <br />55077 04 <br /> <br />NAMED INSlREO AND lIoIAI.lNG ADORE1iS <br /> <br />Effective at 12:01 A.M. stancard time on the datss ~' <br />ebovs st the address of the named Insured this <br />AMENJED DECLARATION ' i1. <br />replaces all prior declaratlcnE;. It any. and witHi" <br />~,rovisions snd endorsemenH;, if any issued to form a <br />thereof complates this PERSONAL UMBRELLA LIABI!.! - .. <br />F'OLlCY. <br /> <br /> <br />AGENT <br /> <br />(510) 548-8200 <br />FIDEL I TY INSURANCE SERV I CE I NC <br />PO BOX 2096 <br />BERKELEY CA 94702 <br /> <br />REX HALVERSON <br />255 CASCADE FALLS DR <br />FOLSOM CA 95630 <br /> <br />OOVERAGE UNITS OFILIABIUTY RETAINEDUMIT . <br />PERSONAL LIABILITY $1 ,000.000 EACH OCCURRENCE $ 250 <br />EXCESS UNIN5\RED AN:> NOT COVERED <br />LN)EIlINSURED MOTORIST <br /> sot:eJ.8 lO OF UNDE1~ YI E <br />T Polic Number Company Limits of Liability <br />PERSONAL L I A81 L I TV Lt-I125806 lA'l:GARD $ 300.000 <br /> 20021251 U>lIGARD $ 500.000 <br />AUTO LIABILITY <br />LIABILITY UA125806 lA'lIGARD $ 500.000 SINGLE, <br />ISC. AlITO L I ASI LI TY 10136859 lA'l I' GARD $ 500.000 SING-E' <br /> <br /> <br />--....;;;: <br /> <br /> <br /> <br />. <br /> <br />TOTA_ ~REM'UM <br /> <br /> <br />ENDORSEMENTS (attached to aoo form ing a pert therE,ofl: <br /> <br />1.03272 03-05. 103270 03-05. 148105 03-05. 154106 03-05. UNO001 10-01, <br />UN0023 05-05 <br />VEHIQE ADDED <br />VEHIQ...E CHANGED <br />RECREATIONAL VEHICLE UNDERLVING ADDED <br /> <br />;#pZIL <br /> <br />II <br /> <br />ADO I T I ONAL PREM I UM TH IS ENDCRSEMENT <br /> <br />DATE - <br /> <br />ACiENC'Y <br /> <br />ct:ILl'fnRSICNED !!IV <br /> <br />05122/07 <br /> <br />150 <br /> <br />SAC <br /> <br />S08EOlllOlIlt>.lirlUCl327l,..". '.;~' <br />, I ."-' <br />'j '1. .. <br />;, 1 <br />," . ,,,.~- <br />