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a~: cpN ;;cQwr <br />L ~ 02 INSURED <br />~b~t~ i!'~JO t j OI J4 51~^OIrC 'nM <br />~ FOR~. PQI.ICY.,SERVICE, >:PLEASE.~.CALL ..~.;. "'""°°`",°"'•"•'"°°~^'~"° ; s'~oi.iCyKUMeER ,,~ <br />. . . . ~,~~ ~,.,~ . <br />. •. : • . •. .' . .. VE EXPIFES . <br />11 ` TI(3AR~~'~~•'~~'~~'~' ~1=800=452~94b3'~ ~`•'•'~ ~ 0 ~89 06/18/90 20-J6-36 ~ = <br />..... . . . .. ...... . .. ..... ... . . .. . . . ... . ......... ..... ....... . . ., ......;.;. ,.• •:•:~ ..:. ..~ :.;:.;;~.;..;....~:.::•:•:•> :~::•:~~~:•:•:u:;~u~u•:~:• >:~:•:v:~ :~:~:~:s: :~>:~:~:~+< :~;>:~: :•:•: <br />ADDRESSEE ~ . INSURED 101 1432457 <br />HELZER, PETER V ~ HELZER, PETER V~ <br />2770 POLK ,2770 POLK ' ~ <br />-. EUGENE, OR 97405 EUGENE, OR 97405 <br /> 541- 2-7 46 05/15/89 <br />YEAR MAKE/MODEL Ven. I.O. No. CLASS SYMBOL TERRITORV ~ VEpR MANE/MODEL Vln. I.O. No. CLASS SYMBOL TERRITORY <br />i 7....TOYOT <br />::P~ 796 <br />51 <br />19 <br />01 ? . <br />4 <br />4 <br />. <br />. <br />................... <br />2: <::::i:::> :»>::::>:<::::::>:<:>?>:<:>z>:<:»;::::>;:<:;:~>:<~ >:': ~::::: <br />~ ..................................... , <br />_. <br />. <br />................ <br />:>::>:::<:>::>:::>:<;>:: >::>:>::>:::::>::::;»: ;:<:>;::»>::>: <br />...........::,.::,,:,:.,.,:.:::.::.~::::<:::::: <br />.... . .. <br />. <br />.. <br />.. <br /><:<: :::;:::::::>:;<:>::»> : `. :<:::::>::> ::>:<:::>::::::::::::~<:»~::<>::::::::::::>:::>;<:>:::«:::>:::::>:: ::: :>::»>:<::~?:<:::> :<:::>::::;:>::::>:<::::>: :<::>:::<:>:>::::<:,:;>;»:>::>::::>::; <br />::.:.:::.:::::.~...5.:::::.::.:::.~::.~.~:.~:::::.~..:....:..::::::::::.:~::.:::::.:::::::::,::::::::::.....:.:::::::::::::..::.:::::::.::: <br />.. ~ ............... . <br />. ........~.....................:.:. ~:::::::::::::: <br />: ~:: .:::::::: <br />~ <br />~ <br />;:.: <br />~ <br />3 s <br />. <br />. <br />::::. ~:: :::::. ~::: <br />~::: <br /><;.;>:;:.::;::.; <br />;;:.::::::>:.;;:.;. <br /> . INSURANCE IS PROVIDED WHERE EITHER~A PqEM1UM OR A"CAV" IS SHOWN'FOR A SPECIFIC CAVERAGE. TNE LIMIT ~OF THE CAMPANY'S LIABILITY FOp ~ <br /> EACH COVERAGE IS SUBJECT TO All THE TERMS OF TMIS POLICY. PREMIUM CHARGES ARE OETERMINED BY THE COMPANY'S RULES ANO RATES. <br /> <br />o <br />BOOILY INJURY <br />T <br />UNINSUHED <br />PROPERTY MEDiCAI <br />~yMENTS <br />~MPRE• ~ <br />QOLUSION <br />Towing b <br />~NTAL <br />REIMBURSE <br />. <br />: ACCI• ,~~ <br />OENTAL <br />pEpSONAL MEDICAI <br />~ <br /> z nousanas of Dollars <br />P YOTORIST DAMAGE <br />« P~v HENS~vE AcNal Cas~' RoaavGe <br />MENT UNINSUHEO <br />MOTOR <br />T . <br />OEATH r C UABILITY <br />PAVMENTS <br /> <br />" Eun <br />ersan/ <br />~~u~^t° Thasanos of <br />Odlars Thasands <br />d DdWrs <br />rn01~nas ~1+~a1 Gun <br />yyue less Yalue less <br />DeOuctiDb Service <br />~~~ iS <br />PHOPERTY .. <br />Thousanas ~ p T~~~as Ddlars <br />~i paiars Eacn <br />PREMIUM <br /> ~ Fac~ Person Eacn dEa~L~rs OeCUCLDb d~ DAMAGE dEacl~irs ~ D Eat~ Person <br /> Eacn AcciOent Occurence pgrspi , ment Person •~ E Occurenu <br /> <br />> <br />~ 100~300 <br />. _;: D0/300 :.. :~0 :> .::::5.,, :::.: :::::::::.:<:::, <br />: :::.. <br />:.:::::::: <br />............... <br />............ ....... ~ <br />~ <br />o ~ :;.>~.;:.:.;;:.;:<.;:;.;:: <br />~ >~~::;:;:>:;::z:;:;:<::; <br />~ <br />J n <br />..... .......... ........... ............... ......................... _ . <br />4 ;::;~:;;:;:;:~;:;:;;:;;;: •: : :::::::: :•::::::::::: :• ::::::::::.~:::. ~::::::::::::; . ::::::::::::::::..:::::.~. ::::::.. :.......... .............. .:..... "ACCIDENTAL DEATH COOES <br />1 r <br />. Fl st N m In r <br />a ed su ed <br />~:$<::~:~:`~:~~::::::~:~>~?~>~~~:~~~i::~ ~~>:.::::;<;::;;::~;<~:~::~"::;~>:~:~~~:;::>~:~:{:~:~:;~: ~:;:~::;::;::~::~>:~:<~~ ~::i~:>:~:~:~~:~:<:::~:~: ~<~::::::<:~':~:»~<:~~;~:::~~~:<~:~~:<>_~>~:':~~~>::>«?;:::~:~~:~:: ~~:«:~:<:::»:::><:~:~:~>:ii>:~::~~~ . <br />.. ......... ... .... _.. . . ....., .. .:.., .. .. . :. ~:. . ~::.~:: . . . , . <br />' : ' " 2. FirsYNamed Insured <br />5 ::.:....................... ....................... .. . 8 Spouse <br />.:: :, ;:;;:: ; :: .:.> :::::: <br />..:..::::::::. <br />::. <br />3. S ouse of Fir <br />::::::>::»::>::::>'s: D <br />: <br />st <br />••:. ^::: :: s <s;: ~ ::;: <br />$:.;: ::;: . :;: : :;:::: . Named Insured <br />a <br />........................................ <br />PREMIUM <br />$ 190 <br />CIGA $ <br />INSTALLMENT $ 0 <br />- ~- _ CHARGE ` <br />TOTAL <br />$ 190. <br />NEWAL EFFECTIVE 06~18/89 ' L DATE DUE ~ AMOUNT DUE <br />- F _ ::> ;~ >:.- <br />" UP•600 (6/88) ~-. DETACH HERE e.;:::;.;::.::. : ,:::: ,; :,;c;::.:;::.;; ; r;;: ;;:<a <br />PIEASE RETURN THIS SECTION WITH YOUR PAYMENT BEFOFiE THE DATE DUE-AILOW 7 GAVS FOR MAIL DELIVERY~ OUTSTANDING <br />~>~I~C~"~~a ~aSUa~ ' THIS OUTSTANDING BALANCE MUST BE <br />f/ ~ L Na~,eo ~r,suaeo HELZER, PETER V PaiO BEFORE THE DarE Sr+ov~N BE~ow <br />P.O. Box 7550, San Mateo, CA 94403 PpLICY NUMBER 20-J6-36 ~6 1$ DATEDUE AMOUNTDUE <br />POLICY RENEWAL $0.00 <br />OUR ANNUAL PREMIUM IS $190. PLEASE PAY THAT AMOUNT BEFORE rr+isrRnNSncrioN <br />06/ 18i89 . TFiE VREMIUM fOR TH~S TRANSACTION MUST <br />BE PAID BEFORE TNE DATE DUE SHOWN BELOW <br />DATEDUE AMOUNTDUE <br />06i18i89 S190.00 <br />~ TOTAL DUE - <br />PLEP.SE DO NOT USE FOR POLICY SERVICE- S190 . 00 <br />CONTACT YOUR BRANCH OFFICE <br />2019636061850190002 <br />