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<br />~ <br /> <br />COMMERCIAL LIABILITY DECLARATIONS <br /> <br />MEMORANDUM COpy <br />D <br /> <br />POLlCY NUMBER: CM28569 <br />NEW POLlCY <br />POLICY PERIOD: 10/04/05 TO 10/04/06 <br /> <br />~. <br /> <br />NORTH STAR MUTUAL <br />INSURANCE COMPANY <br />BOX 48 COTTONWOOD, MINNESOTA 56229-O04~ <br /> <br />- - <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br /> <br />LIMITS OF INSURANCE: <br /> <br />--------------------------.------------------------------------------------------ <br /> <br />GENERAL AGGREGATE LIMIT . . . . . . . . . <br /> <br />$1,000,'000 <br /> <br />PRODUCTS - COMPLETED OPERATIONS AGGREGATE LIMIT . <br /> <br />$ <br /> <br />- 0 - <br /> <br />PERSONAL AND ADVERTISING INJURY LIMIT <br /> <br />$1,000,000 <br />$1,000,000 <br />$ 100,000 <br />$ 5,000 <br /> <br />EACH OCCURRENCE LIMIT . . . <br /> <br />FIRE DAMAGE LIMIT (ANY ONE FIRE) . <br />MEDICAL EXPENSE LIMIT (ANY ONE PERSON) . <br /> <br />FORM OF BUSINESS: <br /> <br />- ._------- <br />ORGANIZATION (OTHER THAN PARTNERSHIP OR JOINT VENTURE). <br /> <br />LOCATION OF ALL PREMISES YOU OWN, RENT OR OCCUPY AND BUSINESS DESCRIPTION: <br />LOC. 01 1801 MAIN ST CENTERVILLE MN, CONVENIENCE STORE <br /> <br />CLASSIFICATION: <br /> <br />CODE PREMIUM ADVANCE PREMIUM <br />NO. BASE PR/CO ALL OTHER <br /> ---------- ------------------------- <br />13673 475,000 $ 586.00 <br /> ~ <br />13454 260,000 $ 258.00 <br /> <br />GROCERY STORES <br /> <br />GASOLINE STATIONS-SELF-SERVICE <br /> <br />PROCESS DATE: 10/14/05 <br /> <br />2 <br /> <br />!5 <br />