|
jj`II'LLIU, SPECIALT'll" INSURANCE,* INC*
<br />W I -),-%
<br />.1 10451 OW I!. f 113 if, � -iv- d I- a �-)Il 1,:; LaTt d I L d • Na fl flia
<br />let)
<br />t i -f t t non va r
<br />CER`1.Fi:cA,rE C),F INSURANCE
<br />!, (A
<br />L
<br />V ..
<br />1
<br />Th i s c f e In i T
<br />c.-.. S, - - r i Li d E.- 6 i I a rt d is
<br />'the c,o1v.:;.--raqa. afforoc-:-d Oly -tf-,a-
<br />n 0
<br />MaT nlr- n f n - m. a o n -?i T1 C1 ni* h 1- e. T
<br />1_"%eL-vw by -a p o L i c v u (ilf- r
<br />Th al p o th-;'-d L
<br />cel's It i If 11 a t 4,~-A i C,- i, AI A. vi c le I nskiva: Tic.*-& isaffordevid ()TiLy lt,;I i t o i p (.-,a C: t t cover-
<br />4.aQes f Or Wn i Ch. i C. --W,PF--C i T I C I. imi I o IF 1, i a., b i L i t a ss 1. 1 e ; % :.. r a. r.. t en- e d �71 -i (-I lib i ec t
<br />ij
<br />-F
<br />sh a 1 L i; d 11' f *Y aTI V pr ol v, I ri i 0 DO u f si 4a, I d o L i a y
<br />In t h fm.-. ,.:venl, alf r.:.a Tice L lat I i,,r. of the pol.lcy,.t tli(.a - company IssuIT19 ii-ijajo4i pol.jr-my
<br />..wltl. ma+;el a L L reascnabLe e ffartm to s-67id Noticc.ot 0� Ca7lCeLta-tioz) to !,hio cert'l*.
<br />■ cl a t e. I i o L I e r a t It h IF n he r i ii, b a t t h e C- 0 (h R a T) Y a S _S U j 1*1 Vii: E. ILI C.-MIS p 1") P.
<br />e adidrnss snow 1 Y.
<br />CIpy ms.zitiwe of" faii.kLi"I LI h
<br />u r te t <*11c 'o 0 S
<br />A i L; r a Tilc_.�- e m a Idle a p il 17 t 0 T t 0 t j C. 1 T! C 1. 31d es a.,;.r: e. v i,-5- o Y,11 j T1 J'
<br />4.
<br />Ill 13 jv� IC o v].on c j: i v r e ii i T a i--: lll a c., -=-I tr utt i a. L i t I • e x h 66"!, i a S 1 �, 0 R. 6, a � t P 0 T 4 P Y' I T) 4:1 0 1- Ca a T1 i •'AL ZI • i Ti ca r (-.ommi f 2 )
<br />o r e i:-i. 1F h ;-,lr t�� 4' I'll 33 iiii ;4 i t c." an CaL r-1
<br />o p v.? r, a a. n, c a u -V o T) L v s b i-; d I Ly n ut r r) r i--) r o p c.tv
<br />I I k ... fie r':uvied 14+n-to,"red jxri 4 •d a i I c: a i i, d by 0 r, t L�) k I rA a f) I.-) v 16- 11
<br />Nl'�'_`IME �v --`-)D'T-13ES3 OF 1"NSURED1
<br />%JI
<br />It "r_k,rTF1r',**.vrE 11OLVE'RO,
<br />'4i"*V1E pi-N ADD13ES%c.`. 0 F C A X..*
<br />1 0
<br />ir
<br />JL 1L
<br />j
<br />C0 $2,fi mil. "Ill a %7e' +
<br />Poll lu til b e r Z
<br />y
<br />L I
<br />o a L ol "i
<br />o e -r A[[,-!� iti a q. EF.
<br />ill L
<br />Y 0 i c.
<br />F
<br />H! in Q 1i l
<br />I ►
<br />LIATIFl• ir-3% -.6 'N'Ir-5 "'r ""r
<br />.:v.
<br />RA Q E
<br />41�
<br />I L Y j y Il
<br />Flmli,r,�jiperty Damage
<br />Fr raper ty 11amage
<br />is 1-
<br />T11 (j
<br />ri a p p e ar s;
<br />.AV
<br />0 N oil I
<br />
|