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11: ~~_ _. <br />~ cor~o~aoo i~~~~ BuR~u . <br />~~ PQMO.f~4eNN~iliEBtt~/M COUNTRY SQUIRE <br />O01G11ACO~'~ POLICY DECLARATION <br />AMENDED DECLARATION <br />EFFECTIVE: 04/26/93 <br /> AOfiNS NAME AND PHONE Nti6®fi8 F.B. No. a~aE <br />CS170435 08/20/92 08/20/93 54-584 PAM YOUNG 087654 1 <br /> 879-4999 i <br />NAMfiD INBURSD <br />OON 8 JUDY SHERROD <br />MYSTIC RT <br />42995 RCR 44 <br />STEAMBOAT SPRINGS CO 80487 <br />PHONE N0. 303-879-3920 <br />TERM: 1 YEAR <br />12:01 AM STANDARD TIME <br />OPERATING AS: <br />INDIVIDUAL <br />WE WILL PROVIDE THE PROTECTION DESCRIBED IN THIS POLICY IN RETURN FOR THE <br />PREMIUM AND COMPLIANCE WITH ALL APPLICABLE POLICY PROYISION3. PROTECTION IS <br />PROVIDED WHERE A PREMIUM, LIMIT OF LIABILITY OR OTHER INDICATION IS SHOWN <br />FOR THE PROTECTION OR COVERAGE. <br />YOUR PROTECTION <br />PROPERTY COVERAGE <br />LIABILITY COVERAGE (OTHER THAN MOTOR VEHICLE) <br />M070R VEHICLE COVERAGE <br />FARM/PERSONAL PROPERTY FLOATER <br />TOTAL POLICY PREMIUM (THIS IS NOT A BILL) <br />THE FOLLOWING DISCOUNTS HAVE BEEN APPLIED TD YOUR POLICY, <br />FLEET <br />MULTI CAR <br />PREMIUM <br />1.249 <br />520 <br />2,045 <br />NC <br />!3,814 <br />1100 <br />1217 <br />FORMS, OPTIONAL COVERAGES AND ENDORSEMENTS APPLYING TO YOUR POLICY: <br />CS-II (04-92) CS102 (05-84) OPT (04-84) OPTION OPTION(04-92) <br />005 <br />S/04/93 <br />NC = NO COVERAGE <br />~~ <br />James M. Cannon Jr. <br />Authorl2ed Representative <br />N• will r•n•w khi• policy, •t eo•p•ny opt ion, upon ree•!p! of r•qulr•d r•n•w•1 pr•~lu. It la n•ea••ary for p•ywant to 6• <br />roc•Svd prior to the end of the currant policy p•rled or covar•g• will •xplr•. <br />