No preview available
Montclair Townhouseseceived: 2/27!0`-~ ~~~ FEB-2'i~ 01:42P FROM:TObW CLERK (845)298-1478 T~'462`272 - a IQ A fv ~ Town Cleric Office: 845.297.5771 N Fax: 845.297.45 AUG p 7 2012 www.townofwapDinger. us TOWN OF ~/~I~iNGER P.O. BNGE s FADS NY 2590 ROAD WAPP ~~~~~~ n~D TOWN OF WAPPINGER TOWN CLERK For The Use Of The Town Hall Facilities For w h' d ~~ S~ ~~ n>da Inge Name of Organization or Group H ~~~ ~ pro e~ me of person representing the Organization or G up ~-Go ~~s^~~ ~ ~~ ~~ ~Q U n e.. ~ ~ ~ ~ ~ h ~~ Phone No. Address in er Town Hall This will confirm the arrangements being requested for your groups' use of the WapP 9 Facilities, as noted below: O i Senior Citizens Room (~,,}/ Large Meeting Room () Other: Specify: A persons ~ ; ~ 4p /Y? The group is not expected to exceed Time: Date{s): It should be understood that groups using the B elddin es; Justice Court, PlanningeBoardS ~ ~) Sind dates when Town Meetings are normally schedul re oasts will be considered upon their own merit, and arrangements can be made for access to, a 4 closing, the building at the close of your meeting. You and your Organization hereby agree to adhere t tion or~g oupt forth on the attached page by signature of an authorized member of your Organize in er reserves the right to suspend temporarily this agreement should the Town The Town of Wapp 9 ses. Advance notice will be given as soon as possible on have need of the facility for its own purpo such occasions. The Town Clerk should be informed promptly of any schedule change or cancellation of your group ities. Arrangements for access to specific area to be used should be made with the Town Clerk activ at the time this form is submitted. o a lication shall be considered approved until it has been submitted to the Town Clerk for review N pP and clearance. disregard or the contracting group as any rou and Terms of this agreement must be strictly adhered to by abuse of the rules for use of the {acHities will result in termination of use by the offending g P, they will not be granted reinstatement. TOwp/S.TC-THF (4-03 Rev) ~ of 3 Agreeme t Received: 2/27/09 5:12PM; 1o4~~ca.. ••_ T0.462zc72 P.3 C845)298-1478 F®-c7~2009 01:42P FROM:TOWN CSC ' Town of Wappinger Town Clerk Agreement for the use of the Town Hail Facilities for Meetings I have read and understand the rules and re hueseioe sui~ement~ of the Facilities in the Town of wappinger Town Hail, and will comply with 4 ed: ~ • Sign ~~ •~ d u ~ 1J1.~ For: (Name of Group or Organization) Dated: v / ~` / Approved: / /~ o~n~Cler Date: t~ A~ °® CERTIFICATE OF PROPERTY INSURANCE DA$/(1/2012 ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. If this certificate is being prepared for a party who has an insurable interest in the property, do not use this form. Use ACORD 27 or ACORD 28. PRODUCER NAMEA Alana Jessie _ DONN GERELLI ASSOCIATES PHONE (914)271-6600 FAX (910)271-3598 1 Croton Point Avenue -MAIL ADDRESS: NY 10520 -H d PRODUCER 00000030 - son u Croton-on INSURER(S)AFFORDING COVERAGE NAIC # INSURED INSURERA:Phlladel hia Insurance CO. _ _ __ __ _ _ __ ~ Montclair Townhouse Condominium INSURERB: ~ __ c/o Town & Country Prop Mgmt ___ INSURER C : __ _ .__,' 3 Neptune Road, Ste A19A INSURERD: ___ _ _ Poughkeepsie NY 12601 INSURERE: ___ _ INSURER F r,w~.~~ rcoTlrlreTC wlnnaFR•Mactar REVISION NlJM6ER: LOCATION OF PREMISES I DESCRIPTION OF PROPERTY (Attach ACOR0101, Additional Remarks Schedule, K more space Is required) Loc# 00001: 1-37 Alpine Drive Wappingers Falls NY 12590 See Attached Overflow Pages - - --_ -- - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ INSR! TYpE OF INSURANCE LTR POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YYW) POLICY EXPIRATION DATE (MM/DD/YYW) COVERED PROPERTY LIMITS ~, }[J PROPERLY BUILDING $ - - I CAUSES OF LOSS .DEDUCTIBLES PERSONAL PROPERTY ~ g ~ _ ~ BUILDING ASIC X II BUSINESS INCOME InClude_ ~ ~- - ,BROAD ~CONTENT$ EXTRA EXPENSE ~ $ ----- ~ _._ A SPECIAL X pHPK778499 2 j I RENTALVALUE ~ $ i EARTHQUAKE L W1ND.~_ ~ -- ~~~ -~~~~ ~ ~ /~~~ ~D I BLANKETBUILDING BLANKETPERSPROP g $ - __.__ FLOOD 7 _ 1 BLANKET BLDG & PP $ ~ ---- X Specal form 5, 00 ~~ ~ ~ ~ ~~ }{ Per Unit -Ice Damming h k E -- ~_ ._ InChlde_. X Special form 25,00 X qua e art $ 1 INLAND MARINE i TYPE OF POLICY GER - ---- $ , _ CAUSES OF LOSS TOW OF WA pIN $ _- ~~ NAMED PERILS POLICYNUMBER T WN C ERK ___ $ I ___ A XJ CRIME PHPK778499 10~1~2011 10~1~2012 X Employee Dishonesty $ 250,00_ TYPE OF POLICY r X Computer Fraud _ $ ___.?~r-Qa Q~ X Forgery and Alterations I $ Q 0 00 BOILER & MACHINERY I $ _ r~ EQUIPMENT BREAKDOWN I $ _ --- SPECIAL CONDITIONS I OTHER COVERAGES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) The certificate holder is listed as an additional insured for the annual meeting. Coverage is provided for thirty-seven two-story brick veneer condominium buildings containing two hundred ninet -six residential units. The remises is located at buildin s 1-37 Aline n~err~onw T~ unr nco CONCFI I ATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Wappinger Town Hall 20 Middlebush Road AUTHORIZEDREPRESENiATIVE Wappinger Falls, NY 12590 Alana Jessie/ICMB ACORD 24 (2009/09) V 'lya5-~uua Al;urcu curcrurw I lun. Hu rlgnrs reserves. INS024 (2oosog) The ACORD name and Togo are registered marks of ACORD COMMENTS/REMARKS Drive, Wappingers Falls, Dutchess County, New York 12590. OFREMARK COPYRIGHT 2000, AMS SERVICES INC. ADDITIONAL COVERAGES Ref # 1 Description 1-37 Alpine Drive,Blanket Building Cov,31,608,730 Coverage Code SPC Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount 5,000 Deductible Type Flat Premium Ref # 1 Description 1-37 Alpine Drive,Extended Replacement,lncluded Coverage Code SPC Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # 1 Description 1-37 Alpine Drive,Backup -Sewers and ,Included Coverage Code SPC Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount 5, 000 Deductible Type Premium Ref # 1 Description 1-37 Alpine Drive,Equipment Breakdown,lncluded Coverage Code SPC Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount 5, 000 Deductible Type Premium Ref # 1 Description 1-37 Alpine Drive,Building Ordinance o,lncluded Coverage Code SPC Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount 5,000 Deductible Type Premium Ref # 1 Description 1-37 Alpine Drive,Building Ordinance 0,300,000 Coverage Code SPC Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount 5,000 Deductible Type Premium Ref # 1 Description 1-37 Alpine Drive,Building Ordinance 0,300,000 Coverage Code SPC Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount 5,000 Deductible Type Premium Ref # 1 Description 1-37 Alpine Drive,Building Ordinance o,lncluded Coverage Code SPC Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # 1 Description 1-37 Alpine Drive,Fire Hydrants Undgnd,1,000,000 Coverage Code SPC Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount 5,000 Deductible Type Premium Ref # 1 Description 1-37 Alpine Drive,Flood,1,000,000 Coverage Code SPC Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount 25,000 Deductible Type Premium Ref # 1 Description 1-37 Alpine Drive,Per Unit -Back Up S,Included Coverage Code SPC Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount 5, 000 Deductible Type Premium OFADTLCV Copyright 2001, AMS Services, Inc. ADDITIONAL COVERAGES Ref # 1 Description 1-37 Alpine Drive,Terrorism,lncluded Coverage Code SPC Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 i Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 7 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description ~ Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium OFADTLCV Copyright 2001, AMS Services, Inc. TOWN & COUNTRY P R O P E R T Y MAN A G E M E N T August 6, 2012 Christine Fulton Town Clerk -Town of Wappinger 20 Middlebush Road Wappingers Falls, NY 12590 Re: Montclair Townhouse Condominium Annual Homeowners' Meeting -October 17, 2012 Dear Ms. Fulton, Enclosed please find the following pertaining to the reservation of the large meeting room at the Town of Wappinger Town Hall on Wednesday, October 17th, 2012, 6:30pm to 9:30pm for the Montclair Annual Homeowners' meeting: • Signed Agreement for the use of the Town Hall facilities • Certificate of Insurance noting the Town of Wappinger as an Additional Insured • Check No. 2821 of Montclair Townhouse Condo payable to the Town of Wappinger in the amount of $100.00 Thank you for your assistance in this matter. Very truly yours, eggy er Town & Country Property Management, Inc. Managing Agent Montclair Townhouse Condominium /ps Enclosures AUG 0 7 ?012 To~N CLERK ER .3 Neptune Road, Suite A19A, Poughkeepsie, NY 12601 tel. 545.462.2270 fax 845.462.2272 e-mail townandcountrypropertymgmtC~att.net FA,CSIMILF ~'RdNSMTx'T11L S~i,~IJT ~.~ ~'C~WN & ~OUNTR~ ~'~C~~~RTY~ M~.N~~EM~~TT Tcx r-itot~z: Wapp~.nge~s 'I'awr~ ~at1 Town & Country Property Mgm#. 10.12.12 F'AX NL'MJIi ~.it ~~, 845.298.147$ I.GGnRnrNC.;: ~~nc,ns (rNrLU17:lNC: c;gyrRP.nG'r.) Re: Hal! Rental 5 MTC Annual Meeting ' Wednesday act 17, 2012 ^ rJx~.rrr~r ^ roR .RLV7.rw ^ ~r ~,~sl~~ cx)uM~N~r ^ Pr rASld xrrrv ©>>r.Fn.sr n~c:~Gt.r N07'f~S/COMMINT$ lJda~L ~PiLtZ[.L~ Admin Assist Town & Country Property Mgmt. 3 NEPTUNE ROAD, SUITS A19A, POUGHKE~PSIE, NY ~,Z601 TEL„ 845.462,2270 FAX $45.q~62.227~ EMAIL: rowN"A.N_ bCOt1NTRYpROPERTYMGM,T c A7T•N.ET ~~.°R°°~ CERTII=ICATE O~ ~'ROPERTY INSURANCE lilo~zo THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THS; CERTIFICATE HOLQER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY pR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFOhOED BX THE POLICIES BELOW, THIS CERTIFICATE pF INSURANCE DOES NOT CaNST1TUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), At1THORIZED REPRESENTATIVE OR PRDDUCER, AND THE CERTIFICATE HOLDER. If fhis cer#iflCatG is being prepared for a party wha has an InsurablA interes# in tho property, tlo not use this form. Ilse ACORD 27 or ACORD 28. PRODUCER NA~IdEn A1~na Jessie DQNN GERELLI ASSC~GZXITES PNON€ (914)27],-5600 ]'FAX (916t~7A-3590 zNSURANCE AGENCX INC _~aM~NO,-~tlt ..... _J..IA/.C, Ne,}. - , 1 Croton pint Avenue ADDRESS:ajess,ieQdgainsuranog.COm •PRtSDUCER 00000030 !_' .- .- - Crptor>-on-Hudson NY 10520 Cu.SIOMFRI[r. ... .,,,, -~.,.,. ... .._.._._~_.-___. ....-,... _,.... _ .-- ,.INSURER(Si AFFOROINA CDYERAGB _.- . _ _NAIC N INSURED - ~ INSURER A:PhilsadglAhfa Instt;'s,~C@_,.Cb. Montclair Tpvrnhou9e Condprainium - -•- -- ---•--- INSURER B c/p Town & Countrx l~xOp Mgmt "- - -- -- ---- INSURSR C ; 3 Neptune Road, ate A19,8,, --~ ---•_ . _.. ,.____, INSURER f).;.• .._ ~... ~ . .....~.~ __._. ......... Qoughkw5epaie NY 12fip7, INSURER~_____---..... __...- .._ _--._-__... ....---.~._...._ COVERAGES CERTIFICATE NUMBERMaster REVISION NUMBER: LOCA71oN OF PpEAgI$ES! DESCRIP110N OF PROPERTY (Attach ACORD101, Adalrygnal Remarks Schedule, ft more apace Isrequlred) Lock 00001: 1-37 Alpine Drivg Wappingers 8'alls NY 1259p S9e Attached pvgrFlota Pages THIS IS TQ CERTIFY THAT THE Pp41CIES OF INSURANCE h~tSTED BELOW HAVE BEEN ISSU ~ -- ED TO THE INSURED NAMEn A9bVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM ;OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSU<w0 OR MAY PERTAIN, 7HB INSURANCE AFFdRDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCFI POLICIES. LIMITS SHOWN MAY WAVE BEEN REDUCED BY PAID CLAIMS. 1NSR LTR TYPE QP INSURANCE _ POLICY NUM9FIi •,• POLICY EFFECTIVE DATE (MMfDDJWYY) - POLICY EXPIRATION Oq'rE (MMlDDlYYWI COVEREp PROPERTY LIMITS ]( PROPERTY kUILDING - -_ ~ CAUSES or Loss . .... DEbUGTIBLES ~ PER,aONAi, l'RdPERTY -~ "' -- s _ - BASIC BUILDING -- }[ USINE53INCOAgF __~.~ .__. .. _ S LOat 1;1Ct:1]d ... BROAD _._. ---•- CONTENTS .._~ - EXTRA EXPENSE _, ... g }\ ~{ SPECIAL,,,., _ . - PHPK924584 10~1~2~X$ 1U~1~20J.~ RENTAL VALUE S LARTwgUAKF BLANKET BUILDING S WIND --. - .. BLANI~T PERS PROP S FLOOD BLANKET BLDG 8. PP _ X ~ Spgdaltonn ___ ._ 5,000 _ }~ Bedap . Sewarx and - ~-~ s ~_x~.~~ua~< .. --- }~ SperJal fMm 25 , 00 x EaMhqualm 5 p9o ooc ~i INLAND MARINE TYPE OF ppL1CY . $ ,, CAUSE OF LOSS 3 NAMED PERILS -_., .. ......r _....._.. .. POLICY NUMBER _.._...._..___ A ~ }~ CRIME PRPK9265B9 IOI1~2Ox2 ~.6~1~201~ ~ Etnpleyea~lahaneery S 250 _( TYPE OFPOI.IOY }( Co;npUlefF7eutl S ~250a-1 .. ~ Fotp9fy and Allargtiona s 2.5.0, c BDIL[R a MACHNERY r °•°- EOUIPMENTBREAKtyOWN i I -.• ~ L~~ _... , ._..._-L._... ~-_.._.....-~.-~...------_____... l a~._..... . SPEGA4 CONDI710N31 OTFIER COVERAGES {AFbEh ACORq 704,Arklltlbnal RemgrkA SawdUle, K mere spgeg Iernquiretll The certificate hpJ.der is li>3ted as an additional insu:c®d for the annual meeting. Coverage is provided for thirty~egven Coro-etoay brick veneer cpz>,dominium buildings captaining two hundred ninety^six residential unite. The premises is located at buildings X37 Arline 511QULD ANY OF THE ABOVE bESCRIEtED POLICI$S BIE CANCELLt;D EIBFOR E THE EXPIRATION DATE TN6REOF, NOTICE WILL HE DELIVERED IN Town pf 4dappinger ACCOpDANCE WITH THE POLICY PROVI5IQNS. Town Hall 20 Middlebush Road AuTFIORI~£OREPRESENraTlvp ' Wappinge~ k'alls, riiY X259o , ~Kathcrine Hova/IdvIB ACORD 24 (2009!09) (~ 7995.2009 ACORD CORPORATiQN. All Mgh#$ reserved. INS024 {2oosr,9~ The ACORD name dnd logo are r2gistered marks of ACORa ApDN71C3NAL COVERAGES Ref # 1 pescriptfon 1-37 Alpine Arivc,Blankot Building COV,31,721,733 Coverage Code SPC Form No. Edition Dote _„~,_ Limit 1 Limit 2 Limp 3 Deductible Amount 5,ooia Deductible Type Premium Ref # Descriptlon Coverage Code Form No. Edition pate 1 1-37 Alpine Drive,Extended Replscement,IndUded SPC limit 1 Limit 2 ~ ~~ Limit 3 Deductible Amount 5,aoo Deductible Type Premium Ref # 1 Descriptlon 1-37 Alpine Drive,Phily ELITE Endarsem,lnc(uded Coverage Cade SPC Foml No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amaunk 5,000 Detluctlble Type Premium ~ Rrf $ 1 DGSCrlptlon 1-37 Alpine DrivF,Equipment Breakdown,InGuded Coverage Cotle SPC Farm No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount 5, aQ0 Deductible Typo Premium Ref # 1 Descriptlon ~~^ ~ ~ ~ 1-37 Alpine Drive,Btlilding Ordinance o,lncluded Coverage Code SPC Form No. Edition Date Limit 1 Llmlt 2 Limit 3 Deductible Amount 5,000 Deductible Type Premium Ref # 1 Description 1-37 Alpine Drive,Building Ordinance o,300,pt]0 Coverage Cotle SPC Farm Na. Editfon Date Limit 1 Llmlt 2 ~ Llmlt 3 Deductible Amount SAOQ poductibie Typo Premium Ref # 1 Description -~ 1-37 Alpini? Brive,guilding Ordinance 0,300,000 Coverage Code SPC Form No. Edition pate Llmft 1 ~ Limit z Limit 3 Deductible Amount 5,000 Deductible Type Premium Rof # 1 Description 1-37 Alpine Drive,l3tiilding Ordinance o,lncluded Coverage Code SPC Form No. Edition Date Limit 1 Limit 2 Limit 3 poductible Amount Detluctlbie Type Premium Ref # 1 Descriptlon Coverege Cade 1-37 Alpine Drive,Fire Hydrants Undgnd,1,o40,Qa0 SPC Form No. Edition Date Limit 1 Limit x ~ Limit 3 Deductible Amount 5,000 Detluotible Type Premium ~M Ref # 1 Description - 1-37 Alpine Driue,Flcod,1,000,o{)D Coverage Cade SPC Form No. Edition date Limit 1 Limit 2 Limit 3 Deductible Amount 25,000 Deductible Type Premium ^ - Rof # 1 bsscription ~37 Alpine f~rive,Per Unit -Back Up S,Included -~ Coverage Code 5PG Form No. Edition Date Limh 1 limit x Llmlt 3 peducNbte Amount 5,000 peductlble Type Premtum OFA~TI_GV Copyright 2001, AlN3 Services, inc. ADQITI~NAL C~V~RAG~S Ref # 1 Descrlptlon 1-37 Alpine 1:3rive,Per Unit -Ice Dammi,lnd~ided , Govarega Coda SpC Form No. Edition Date Limit ~ Limit 2 Limit 3 Deductible Amount 5,000 D9tluctible Type Premium ___ Ref # 1 Description _ y 1-37 Alpine Drive,Terrorism,lnduded Coverage Code SPC Form No. Y Edition bate Llmlt 1 Limit 2 Llmlt 3 Daduc6bie Amount Deductible Type Premium Ref # Description Coverage Gode Farm No. Edttlon Data Limit ~ ~ Limit 2 Limit 3 Daductibip Amount Deductible Type Premium Ref ~ aescrlptlon ^rv Coverage Coda Form No. Edition Data Limit 7 Limit Z Limit 3 ~ Deductible Artsount Deductible Type Premium Ref a- Descrlptlon '~ Coverago Code Form No, Edition Date Limit 1 Limit 2 Limit 3 Deductible Amaun# Deductible Type Premium Ref # Description - Coverago Code Form No. Edition Da#e Limit 1 ~ Limit 2 _ Llmlt 3 Deduaklbla Amount DeducGbla Type Premium Rof # Description Caverega Gode _. .. . . Llmh 1 _ Limit R Limit 3 Daduokible Amount Deductible Type _..,.. _1„ ..,, Font No. Edition Date Premium Raf # Descrlptlon Coverage Code Form No. Etlition Date Llmlt 1 Llmlt 2 Limit 3 ~ Deductible Amount Deductible Typa Premium Ref # Description Covarag+s code Form No. Edition pate Limit 1 Llmlt 2 Llmlt 3 Deductible Amounk betluctlbla Type Premium Ref # Description Goverage Code Form No_ Edition Date ~i Lima 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium ~_- ~ ,. Raf st' Description Coverage Codo Form No. Edition Data Limit 1 Limit 2 Liml# 3 Deductible Amount Deductible Type Premium y OFADTLCV Copyrigh# 2001, AMS Services, tnc.