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<br />02-17-06 <br /> <br />Damage Due to Blasting YES <br />Damage Due to Collapse YES <br />Damage Due to Underground Facilities YES <br />Broad Form Property Damage YES <br /> <br />AUTOMOBILE LIABILITY: <br />Policy No. <br />Effective Date: <br />Insurance Company: <br />(X) Any Auto <br />LIMITS: [Minimum) <br />Bodily Injury: <br />$500,000 each person <br />Property Damage: <br />$500,000 each occurrence <br /> <br />Expiration Date: <br /> <br />$1,000,000 each occurrence <br /> <br />-OR- <br /> <br />Combined Single Limit Policy: <br /> <br />$1,000,000 each occurrence <br /> <br />ARE ANY DEDUCTIBLES APPLICABLE TO BODILY INJURY OR PROPERTY <br />DAMAGE ON ANY OF THE ABOVE COVERAGES: <br /> <br />If so, list: <br /> <br />Amount: $ <br />[Not to exceed $1,000] <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL MAIL TEN <br />(10) DAYS WRITTEN NOTICE TO THE PARTIES TO WHOM TIDS CERTIFICATE <br />IS ISSUED. <br /> <br />Dated at <br /> <br />On <br /> <br />BY: <br /> <br />Authorized Insurance Representative <br /> <br />Q:\AgreementsIPheasant Marsh 3\Pheasant Marsh 3rd Addition V14.doc <br /> <br />Page 27 <br /> <br />1/ <br />