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1 yjldwestl vitztual <br />Insuring Midwest Values <br />Since 1891 <br />Renewal Coverage Summary <br />DB <br />PgLIG f NI1N1i3ER ---- _ 17fl#-1t2.Y : P ERPD CEI <br />GRMN0560025417 08/17/10, 08/17/11 <br />LAME ;:INSUREIAND AD <br />LAWRENCE JOSEPH FERBER <br />DBA: LARRY'S AUTO BODY <br />17441 BAUGH ST <br />RAMSEY, MN 55303 <br />12:01 AM STANDARD TIME <br />AGEt,F <br />00250 <br />ASPEN AGENCY LLC <br />2669 COON RAPIDS BLVD NW <br />COON RAPIDS, MN 55433 <br />Phone: (763) 755-7000 <br />BUSINESSOWNERS SUPPLEMENTAL DECLARATIONS <br />LOCATION ADDRESS(ES) <br />Prems. Bldg. <br />No. No. Address <br />1 1 17441 BAUGH ST, RAMSEY MN 55303 <br />Prems. Bldg. <br />No. No. Occupancy <br />1 1 Auto Body or Paint Shops <br />DESCRIPTION OF PREMISES <br />COVERAGES PROVIDED <br />Prems. Bldg. <br />No. No. <br />1 1 <br />1 1 <br />Coverages <br />Building - RC <br />Personal Property/Contents - RC <br />COVERAGES <br />19 <br />Construction <br />Frame <br />Limit of <br />Insurance <br />$94,800 <br />$19,000 <br />Automatic Increase <br />in Insuranc <br />6% <br />6% <br />Ded <br />$1,000 <br />$1,000 <br />OPTIONAL COVERAGES <br />Prems. Bldg. <br />No. No. <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />Coverages <br />Uninsured Motorist <br />Underinsured Motorist <br />Personal Injury Protection <br />Non -Owned Auto Liability <br />Loss of Income/Extra Expense <br />Garagekeepers- Collision - Primary <br />Garagekeepers- Comprehensive - Primary <br />Limit Ded <br />$500,000 <br />$500,000 <br />$0 <br />$1,000,000 <br />ACTUAL LOSS SUSTAINED <br />$60,000 $1,000 <br />$60,000 $1,000 <br />DATE 07/20/2010 <br />PAGE 2 <br />