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<br />Memorandum of Insurance <br />Company <br />~ Horace Mann Insurance Company <br />^ Teachers Insurance Company <br />^ Allegiance Insurance Company <br />Name and Address of Lienholder: <br />polloy p 43 - 19618220 <br />EFFECTIVE DATE EXPIRATION DATE <br />nwHrH ar r~7t worm, wr rFrw <br />5 15 91 11 16 91 <br />Name and Address of Insured: <br />Tim Chervick <br />Swift Creek Consulting <br />618 East 1440 South <br />Vernal, UT 84078 <br />YEAR, MAKE & BODY TYPE IDENTIFICATION N PHYSICAL DAMAGE COVERAGES <br /> <br />82 D <br />d <br />P/U <br />LB7FD14RSCS2981115 COMP COLL <br />o <br />ge ;:100 Ded. #250 Col. <br />Loss Payable Clause <br />Bodily Injury ;250,000 ea. <br />(500,000 ea. <br />Property Damage <br />;300,000 ea. <br />?- <br />c_ <br />e: <br />Wo agree that loss or damage under this policy shall be paid to you and the loss payee shovun in the Declarations <br />as interest may appear. <br />The insurance covering the interest of the loss payee shall apply except it irnra{idated by your fraudulent acts or <br />omissions. But, we have the right to cancel this policy as provided by its terms and the cancellation shall terminate <br />this agreement with respect to the loss payee's interest. When we cancel, we will give the same advance notice of <br />cancellation to the loss payee as ws give to the policyholder shown in the Declarations. <br />When~we pay the loss payee we are entitled to the extent of the payment, to the loss payee's rights of recovery <br />~o c(• ~7 ~ U/G ~ ~' <br />~h~1 ~r(~ ~ 3G 5((~ <br />I ~- <br />u <br />j 3~•~ <br />Authorized Agent <br />~c~ry` d° <br />~ ~~ <br />~-~~•~i <br />Date 6!27!91 <br />CL-V06006 <br />