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dIY li" <br /> ������� 1�� ,u ilk, s"� � "" IN IIIA IIIN � �u � VIII" IIIII �°° <br /> puiruulllIIIIUIry lllluitururd'� irlllur, muirmuimmm,rINUIVaium �I"ratlllmia <br /> I ilivilveirWity AveirweWest Stw IPaiul, IWIN 1.551,03-.20,44 IIPlhmc.mrui r (651) 21115-4173 <br /> IN IaN���Aici N° IIII IIIc „Iwrl Ilil�ium 111 '! li' � <br /> II °� <br /> IdIllrlaU "�IIIr Standard gar, IIIr� II °'1�iiitlll1� , �������aN; � ,�"t��" III�1I $25,01010 <br /> IENTERVIILLIE, CITY OF r ement No,: ` C 1001616_ -3 <br /> 1366 MAIN ST Agreement Pedoda <br /> GEN"'III''1ERVilNI,,,,N,,,.111;;;!„ MN 556311-9794 From. 03/01/2019 <br /> To: 03/0112020 <br /> E.::rnclos d is a qu ir:vIt.atl rn fnir uvorlm. nrs"compensatiori deposit Ipir irinlurrm.. 1w otmmm Ft rm wal Coverage,wiIIIll be boiuuurmd as <br /> 1p it tille explirlin, olv iu'gym arr nl! irmmuBinll, lUunCIIILirirt!IIMM Dr V9111° f <br /> .je trmir iiulslU to d arvid appolfirifted u I it ml m my ltlwuu the <br /> Ipreirrrmiiini,mrrn iiurudlile ted of n Ithe rtu ta, isinillle VI' im rrmb it rwr ageirft siir.pinds a wvrifteirm uregt,uet inotto blind ureinmm -alll <br /> 1E.E TIIIIM "'r1l::.E,;t DIII::::.R::V <br /> r llrl. lll...11l Ilrldl"limr'�t°"dr�lllllr°°NrIIbON ' IIC"111111111111 <br /> ............................................. ...................... t IRA 1IIN... Ir. 11L..111... 1 1JI,IIIIa�1111 <br /> i111fiii!Iliiii! .11 1AG! SCII FOR EYE°'rAlllll...S <br /> Manual Premium 26„620 <br /> IE.:.:xpedence Modification Om -4,093 <br /> Standard Pr ium 21,521 <br /> Deductible Credit 0.00% <br /> Premium Discount 1,569 <br /> Net Deposit Premium 19,952. <br /> Agent: <br /> 06766 Paul H Steffel Insurance <br /> 7629 26tlhm Ave <br /> Centerville, IVIN 65036 <br /> res '1 of 3 LM451,16(3111 ) i ,v 11,16) <br />