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• <br /> 221030 <br /> NAMED INSURED POUCY PERIOD POUCY NUMBER <br /> BRIAN&LEAH BJORKMAN 05/16/2013 to 05/16/2014 PX 261 38 45 <br /> FORMS AND OPTIONS APPLICABLE TO PRIMARY RESIDENCE PREMISES <br /> PLE 2044 0803 Limited Mold or Other Fungi Coverage <br /> PLE 2064 0809 Travel Rescuer <br /> PLE 2065 0912 Pet Protector <br /> PLE 2066 0912 Homeowners Plus <br /> SUPPLEMENTAL HOMEOWNERS INFORMATION-Primary Residence Premises PREMIUM <br /> PLE 2014-Scheduled Personal Property(Jewelry-Scheduled) <br /> Deductible: None <br /> Amount of <br /> Description Insurance <br /> 1. ONE LADIES 14KTYG DIA WEDDING RING SET W/1 $ 7,100 <br /> MED FULL CUT DIA.77CT VS1 CLARITY I COLOR <br /> SET W/6 RND FULL CUT DIA MELEE APPROX <br /> 24CTIW 811 CLARITY G-H COLOR SOLDERED <br /> TOGETHER • <br /> 2. ONE LADIES 14KTYG MOTHER CHILD PENDANT $ 3,900 <br /> SET WITH ONE RND FULL CUT DIA.51CT SI1 <br /> CLARITY H COLOR ALSO WITH 2 GENUINE • <br /> BIRTHSTONES SEPT&JULY ATTACHED TO 181 BOX <br /> LINK CHAIN <br /> Total: $ 11,000 . $ 88 <br /> PLE 2016-Snowmobile and Recreational Vehicle Coverage Form <br /> Type of Deductible Amount of <br /> Property Description CC Property Amount Insurance <br /> 2003 HONDA RUBICON 500 All Terrain Vehicle $ 250 $ 4,000 $ 71 <br /> #478TE2602342063 <br /> PLE 2028-Snowmobile and Recreational Vehicle Liability Coverage <br /> Type of <br /> Property Description CC Property <br /> 2003 HONDA RUBICON #478TE2602342063 500 All Terrain Vehicle $ 44 <br /> Additional Residence Occupied by the Insured <br /> Liability Extended to: LOT 5 NORTHWOOD SECOND EDITION,FARGO ND $ 10 <br /> 58102 <br /> Thia yApr2505:17:522013 <br /> PRO 0600 9806 AGENT COPY .Page 5 o15 <br />