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<br /> 1m NORTH DAKOTA INSURANCE RESERVE FUND <br /> p,O, BOX 2258 <br /> BISMARCK, NO 58502 <br />'- "i,' '.. .,', , " ':::ME:MORANDUMNUMBER:.: : FROM : 'p~Y~~E P.Efl.i?[);;:'-'J-i:i . <br />' . - . <br />~.:~,:~r\0;:~,t} 08/01/2005 I 08/01/2006 <br />'-""'''\;ASS COUNTY GL 987 19 <br /> MIKE MONTPLAISIR, AUDITOR ., AGENt "..,.... ',"""'i. ~ <br /> PO BOX 2806 <br /> FARGO, ND 58108 DAWSON INSURANCE AGENCY INC <br /> PO BOX 1958 <br /> FARGO ND 58107-1958 <br /> PHONE NUMBER: 701-237.3311 <br /> LIABILITY MEMORANDUM OF COVERAGE <br /> DECLARATIONS <br /> The Named Member is a member of the North Dakota Insurance Reserve Fund (NDIRF) with all rights and responsibilities <br /> set forth in the by-laws, <br /> Coverage does not apply to loss under a coverage part which occurs prior to the Retroactive Date, if any, shown below, <br /> Coverage is provided only for those coverage parts indicated by a contribution or the term "Included" in the contribution <br /> section below, <br /> This Memorandum of Coverage does not constitute an insurance policy or insurance contract within the meaning of Chapter <br /> 32.12.1 of the North Dakota Century Code. The limit of liability afforded the Named Member under this Memorandum is that <br /> specified by Chapter 32-12,1-03(2) of the North Dakota Century Code, two hundred fifty thousand dollars per person and five <br /> hundred thousand dollars for injury to three or more persons during a single occurrence, The limit of liability shown below <br /> applies in the event of a judicial determination that the statutory limit of liability is not applicable to a specific occurrence, The <br /> NDIRF is a self.insurance pool within the meaning of Chapter 26.1-23.1-02 of the North Dakota Century Code, Membership <br /> in the NDIRF does not constitute any form of waiver, modification or limitation of any immunity or limitation of liability that <br /> is available with respect to a particular claim or "suit", <br />'" <br /> COVERAGE PARTS RETROACTIVE LIMIT OF LIABILITY CONTRIBUTION <br /> DATE PER OCCURRENCE <br /> A) Personal Injury and Property Damage Liability 811/2005 $2,000,000 INCLUDED <br /> B) Medical Payments Not Applicable $1,000 INCLUDED <br /> C) Governance Liability 811/2005 $2,000,000 INCLUDED <br /> Forms and endorsements contained in this Memorandum of Coverage at <br /> inception: IL 80 01 01 91 GL 10 01 01 2005 GL 20 02 01 91 CONTRIBUTION $ 153,940 <br /> GL 30 01 01 91 GL 50 50 07 98 <br />, ~_~uJ_ <br /> GL 90 01 01 2005 <br /> AUTHORIZED R PRESENTATIVE <br />