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- UMBKELLA MAKE CHECK OR MONEY ORDER PAYABLE T0: <br /> <br /> ` P01;[Y <br /> DECLARATIONS ? FARMERS INSURANCE EXCHANGE ? TRUCK Itr3t1RANCE EXCHANGE <br /> t JIr1d BL1S I tJE:SS <br /> 1. Named IIR~TEtJ 3Qt~JES Prod. <br /> Insured c~t319 ALt>ER ST i Count <br /> Address E1JGEhilw C1F< ??'tC'°.! Acc't Ns~o. <br /> Agent Policy Number <br /> Please write your Policy Number on Check <br /> 2. Effective <br /> From: or'cS,'c^..0<iG To: o^:'c^.~,i2401 <br /> (not prior to time applied or) 12:01 A.M. Standard Tilne, at the address of the named insured <br /> 3. Schedule of Underlying Insurance (Entries in thousands of dollars.) <br /> CARRIER POII(Y NUMBER COVERAGE UNDERLYING LiMiTS <br /> FIE l~o~~ E,b~.1~ FaUTO >rtIlF'D 2,~.+r?/Si~C+!1C,+t+ <br /> F I C ° 1381 8 1 c CF1. 3G0, 000 <br /> IMPORTANT NOTICE You have told us you have underlying insurance policies with liability limits listed above. If your underlying <br /> insurance policies have lower limits than shown above, you will be unprotected for the difference. You must keep the above <br /> coverages and limits in effect to avoid these gaps in your protection. <br /> 4. The insurance afforded is indicated b s cific limit and premium charge or charges. <br /> LIMITS Of LIABILITY <br /> $ I ,000,000 Each Occurrence <br /> $ Retained Limit <br /> Premium Limits of Liabil" Ex osure Quant" <br /> $ 1 ~ . 00 $1 Million . Owner-occu led residence 1 <br /> $2 Million Motorized vehicle" 1 <br /> $3 - $5 Million UM/UIM (where available) 1 <br /> 13O.Oft Total Premium Driver under a e 21 <br /> Cash Received Unlicensed recreational vehicle <br /> 130.OO ~ Balance Due U n Recei P Sailboat <br /> Refund Household oints <br /> Powerboat <br /> Rental Dweliin <br /> On Premises Office <br /> • Any "'T'OTAL" balance or credit less than Off Premises Office <br /> $7.00 will be applied to your next Insured as an Em to ee <br /> billing. Balances $7.00 or more are due Teacher Liabili <br /> upon receipt. Incidental Farmin (total acres) <br /> • • Motorized vehicle includes all autos, Vacant Land (total acres) <br /> trucks, motorhomes, motorcycles, Farm Land (total acres) <br /> and licensed recreational vehicles. Farm Land Leased to Others (total acres) <br /> Child Care children cared for) <br /> et Ski/ et Sled <br /> ENDORSEMENTS APPLICABLE TO THIS POLICY: (If Monthly Pay, see E0022 or E0025 in Oregon) <br /> ECll1l 3RD ED REMINDER <br /> PLEASE RETURN WITH PAYMENT <br /> IN THE ENCLOSED ENVELOPE <br /> Your returned check~y~f~t~ipt <br /> Countersi~led FARMER S <br /> Au[horized Reprexntative <br /> 565398 8-99 ISSJ' EDfnoiJ 1701 <br /> <br />