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CERTIFICATE OF INSURANCE <br /> SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER WILL NOT BE CANCELED OR OTHERWISE <br /> TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED BELOW. BUT IP1LNO <br /> EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM THE DATE WRITTEN_THIS CERTIFICATE OF INSURA=E <br /> DOES NOT CHANGE THE COVERAGE PROVIDED BY ANY POLICY DESCRIBED BELOW. <br /> This certifies that: ® STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington. Illinois.or <br /> ED STATE FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois <br /> has coverage in force for the following Named Insured as shown below: <br /> Named Insured Ward, Ray M. <br /> Address of Named Insured 30193 Highway 184 <br /> M Dolores, CO_ 81323 <br /> POUCY NUMBER <br /> s66 5723-BOS-06J-0 1 <br /> EFFECTIVE DATE <br /> OF POLICY Feb. 05 98 <br /> DESCRIPTION OF <br /> VEHICLE 1984 Peterbi It <br /> LIABILITY COVERAGE Tj YES L NO CI YES 0 NO 0 YES Q NO Q YES 7 NO <br /> LIMITS OF LIABIUTY <br /> a. Badly InIL y <br /> Person 759,099 <br /> Each A=idwn 750,000 <br /> b Property Da—ge i <br /> Eam Arsaett 750,000 <br /> Eaan Accident 750.000 <br /> PHYSICAL DAMAGE I 0 YES 00 NO <br /> COVERAGES 1 ❑ YES Q NO LJ YES Cf NO Q YES J NO <br /> a Comprehensive S--- Deductible S neauctibie S _ Deductible S Deducttgo <br /> YES C) NO Q YES Q NO =YES =NO 0 YES 0 NO <br /> b. Corksion Deductible S Deductble S owuaioie <br /> EMPLOYIER'S <br /> NON-OWNERSHIP YES © NO YES Q NO 0 YES rl NO YES n NO <br /> COVERAGE <br /> HIRED CAR COVERAGE YES © NO Q YES Q NO YES C NO YES L�( NO <br /> Agent 161-9 <br /> Signature of Authonzed epresenta a Trtle Agent's Code Number 5vatte- <br /> Name and Address of Certificate Holder Name and Address of Agent <br /> Division of Minerals & Geology Dennis Morita State Farm <br /> 1313 Sherman St. ROOM 215 25 N. Harrison St- <br /> Denver, CO. 80203 Cortez, CO. 81321 <br /> L J L J <br />