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UMBRELLA LIABILITY; <br />Policy No. Inception Date Expiration Date <br />Insuring Company <br />Single Limit Liability: $ Retention: $ <br />OWNER'S PROTECTIVE OR RAILROAD PROTECTIVE LIABILITY: <br />Policy No. Inception Date Expiration Date <br />Insuring Company <br />Name & Address of Insured <br />limits of Liability: <br />Bodily Injury Liability $ Each Occurrence Combined <br />Property Damage Liability $ Each Occurrence OR Single $ <br />$ Aggregate Limit <br />SPECIAL COVERAGE: <br />Policy No. Inception Date Expiration Date <br />Insuring Company <br />Name b Address of Insured <br /> <br />unt <br />uctible <br />MORTGAGE CLAOSE- ~_ -`- <br />Loss, if any, to be adjusted only with the insured named herein and payable to the insured b <br />as their respective interests may appear, subject, nevertheless, to all the terms and conditions <br />of the policy and the Standard Mortgage Clause, U. S. Form No. 127 B (9-34) <br />CANCELLATION: Should any of the above described policies be canceled before the expiration <br />date thereof, the issuing company will mail~_days written notice to the below named <br />certificate holder, but failure to mail such notice shall impose no obligation or liability <br />of any kind upon the company. <br />Colorado Department o atura esources <br />ine an ec amation ivision <br />3 5 erman St. <br />enver, CO 0203 <br />This certificate is issued as a matter of information only and confers no rights upon the <br />certificate holder, This certificate does not amend, extend or alter the coverage afforded <br />by the policies listed above. ____._ _ -_ -- - - __ -'- -' <br />- - ~ <br />Countersigned By: <br />P. 0. Box 54 <br />Madison, 1 53711 <br />Authorized Representative <br />608/273-1371 <br />