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<br />. <br /> <br />IVlay L.':::J U(j UL:L(jP I A::>::>A CUN::>/ I' liNG <br /> <br />tt).c'j-cOOI::1 lq= k1j H-LVt:::l<l;)lJ'.I '3 '.::It:1=:I- (~jl <br />r~r~urllU ^UCO ,..01 ICY - lolIf IJOrn'lI <br /> <br />Declara'ion Page 1 of 3 <br /> <br />" · 6-444-0042 <br /> <br />p.4 <br />/-'H(:iC 1 <br /> <br />Company: <br />Unigard Insurance Company <br /> <br />Potier NUMber: <br />UA125606 <br /> <br />NIIIIICd ,"HIed: <br />Rex Halverson <br />255 Cascade F8b Or <br />Foisom CA 95830 <br /> <br />eUNIGARD <br /> <br />P.O. Box gQ701 <br />BefkJwe. WA 90009 <br /> <br />Ch.... To Vow PvIIcy <br />dfectift; ~ <br /> <br />AgeftI: . <br />Fidelity Inannce S*V1ce1nc <br />PO Box 209& . <br />a.rtceI.y CA 84102 <br />(510) 546-8200 <br />No pwtnNM dIIlf'enc& <br />for..... ch..... <br /> <br />Mt.llidcd DedM~ ....... Oft 08f11/Oi <br />........,.. aI prior decMlations, . any. .,d with <br />poIcJ provlsklns and endo....luo.. latty, <br />iaued tea fom . '*' ther80f CGmJI,'" .. <br />~ Auto Poley. <br /> <br />01 BMW replacecf WIh 01 MERZ <br />~ r....... on 0111MW1 <br /> <br />os M ERZ revised <br /> <br />Polic:y period from 07fOalO7 tQ 01"" <br />.12:01 A.M. ~ time "the <br />addrea. of the ...... iMUnd.. <br /> <br />~.. ~.., wt.eree prernUI <br />and . liMit of'''''''' .. aItown for the <br />cGWIMIge. <br /> <br />eover.oe Part <br /> <br />u.... of u.biItr <br /> <br />Vehicle Pre........ <br />1 2 <br />08 LfERZ 01 8MW1 <br /> <br />A. liability <br />eoc.ty Injury iIlOd Property D.iunilge 1500.000 MCh accident <br /> <br />. 8~ ~I p&yMe,",1B <br /> <br />. 5,000 Irnit <br /> <br />S 188 $201 <br />S 15 .'17 -. :~p .-- <br />$32 $30 <br />$65 $52 <br />S200 d&d $20() ded <br />$133 S 131 <br />$500 ded S500 ded <br />$ 4 S " <br />$ 12 $ 12 <br />$ 12 S 12 <br />$"1 $459 <br />$ 100 <br /> <br />c. Uninsured MaIIDrist <br />Bodily In~ <br /> <br />D. Damage To Your AUlD <br />oth<< Than Collision <br /> <br />$100,000 each accident <br /> <br />actual cash ".... <br />minus deductibre <br /> <br />Cof&&ion <br /> <br />actual caah v-... <br />mlnul deductible <br /> <br />Addition.. Cove,...: <br />T owinv and Labor <br />Increased Tr_~ Expense S 30 per day JS900 ....imum <br />WlliWrol~ ~ <br /> <br />Total ....... by ve,.. <br />ToW premiuM for poIicj period <br /> <br />THAAK YOU FOR CHOoSING UMGARD F()R YOUR INSURANCE NEEDS. <br /> <br />100TTlCA <br /> <br />~ze"Q I 4J'.., <br />