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PART B DECLARATION PAGE <br />dwest1 Mutual <br />Insuring Midwest Values <br />Since 1891 <br />ROIICY.NIMBER .::•... <br />GRMN0560025417 <br />MIDWEST FAMILY MUTUAL <br />INSURANCE COMPANY GARAGE BUS 1 NESSOWNERS <br />P.O. BOX 9425 Minneapolis, MN 55440-9425 <br />FROM: <br />POLICY PERIOD 7E.... < . <br />Renewal Coverage Summary <br />08/17/10) 08/17/111 12 01 AM STANDARD TIME <br />AiVfEl i 1NS. JR I ... D ADDRES <br />LAWRENCE JOSEPH FERBER <br />DBA: LARRY'S AUTO BODY <br />17441 BAUGH ST <br />RAMSEY, MN 55303 <br />00250 <br />DB <br />ASPEN AGENCY LLC <br />2669 COON RAPIDS BLVD NW <br />COON RAPIDS, MN 55433 <br />Phone: (763) 755-7000 19 <br />Tool Floater Coverage <br />Description <br />Serial Number <br />Value Deductible Premium <br />FORM SCHEDULE <br />Forms and Endorsements applying to this Coverage Part and made part of this policy at time of issue: <br />FORMS APPLICABLE TO ALL PREMISES AND COVERAGES <br />- Form- -- -Edition- - — Description - -- Loc-Item- -Ded Limit_ Premium <br />BP0002 06-89 Businessowners Special Property Coverage Form <br />BOP0996 05-00 Deductible Clause <br />BP 05 15 01-08 Disclosure Pursuant to Terrorism Risk Ins Act <br />BP-05-26 01-08 Nuclear, Bio, Chemical Terrorism Exclusions <br />BP0009 06-89 Businessowners Common Policy Conditions <br />BP0125 06-90 Minnesota Changes <br />BP0412 01-87 Limitation of Coverage to Designated Premises <br />BP0417 06-89 Employment - Related Practices Exclusion <br />CA0005 06-92 Garage Coverage Form <br />CA0218 01-92 Minnesota Changes - Cancellation & Nonrenewal <br />CA2505 06-92 Garage Locations & Operations Med Payment Coy <br />GAR0001 10-92 Policy Conditions <br />GAR0002 10-92 Garage Property Amendatory Endorsement <br />IL0003 06-89 Calculation of Premium <br />IL0017 11-85 Common Policy Conditions <br />IL0021 11-85 Nuclear Energy Liability Exclusion Endt <br />MFM 001 01-08 Policy Holder Notice <br />MFM-GRO1 01-08 Dealers Covered Auto Symbols <br />MFM-GRO2 01-08 Drive Away Collision Extension <br />MFMBP-02 01-09 Asbestos Exclusion <br />PRIV NTC 07-01 Privacy Policy Notice <br />BOP 0006 06-89 Liability Coverage Form <br />CA 21 24 01-90 UM/UIM Motorist Coverage - MN <br />CA2225 12-96 MN PIP <br />DATE 07/20/2010 <br />PAGE 3 <br />