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221030 <br /> NAMED INSURED POLICY PERIOD POUCY NUMBER <br /> BRIAN&LEAH BJORKMAN 05/16/2013 to 05/18/2014 PX 261 38 45 <br /> Includes the following Discounts and/or Surcharges: <br /> Air Bag Discount Driving and Insurance Record Surcharge <br /> Financial Stability Discount • FM Walleyes Unlimited Inc Group Discount <br /> Multi-Car Discount Package Discount <br /> Passive Anti-Theft Discount Select Pay Plan Discount <br /> Valued Policyholder Discount <br /> DRIVERS FOR AUTO 2 <br /> Principal Driver. LEAH BJORKMAN Occasional Driver. <br /> Usage Miles to Work Days per Week Annual Mileage Years Insured <br /> Work 5 5 10,000 7 <br /> LOSS PAYEE(S)/ADDITIONAL INTEREST(S)/ADDITIONAL INSURED(S) <br /> • <br /> • Loss Payee <br /> AFFINITY PLUS CREDIT UNION <br /> ' PO BOX 24067 <br /> FORT WORTH TX 76124 <br /> FORMS AND OPTIONS APPLICABLE TO AUTO COVERAGE <br /> PKP 0005 0803 MILE-STONE Package Policy(Auto) <br /> PLE 3030 1301 Basic Personal Injury Protection Coverage-North Dakota <br /> PLE 3032 1301 Uninsured Motorists Coverage-North Dakota <br /> PLE 3033 1301 . Underinsured Motorists Coverage-North Dakota <br /> PLE 3034.1104 Auto Loan/Lease Coverage <br /> PLE 3035 0511 Towing and Labor Costs Coverage <br /> PLE 3036 0511 Auto Rental Expense Coverage <br /> PLE 3072 0912 Air Bag Deployment Coverage <br /> HOMEOWNERS COVERAGE <br /> PRIMARY RESIDENCE PREMISES BRIAN&LEAH BJORKMAN <br /> 2525 NORTHWOOD DR <br /> • <br /> FARGO ND 58102 <br /> COVERAGES AND UNITS OF LIABILITY <br /> A-Dwelling B-Other C-Personal D-Loss of E-Personal Liability F-Medical Payments to <br /> Structures Property Use (Each Occurrence) Others(Each Person) <br /> $311,000 $62,200 $233,250 $155,500 $500,000 . .$1,000 <br /> Property loss Is subject to$ 1,000 Deductible <br /> Inflation Protection: 4.0% • <br /> Thumdry Apr 25 06:1782 2013 <br /> PKD 0800 9808 AGENT COPY Page 3 of 5 <br />