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<br />02/28/2005 12:30 <br /> <br />5192397105 <br /> <br />NEW CITY AMERICA <br /> <br />PAGE 04 <br /> <br />ecw'-"nLAUTDII08U <br />COVERAlIlE PART. DECL.a1U11ONS <br />BlBIl7'o. Atn'O COVERAllS FORII (CanIInuId) <br /> <br />POIJCY~ 72 mr:: tL9"3 <br /> <br />IIBITWD.8CHEIMJlE OF c:cntIR,A-- AIlD COVERID AU1'08 <br /> <br />Thl$ policy PI'llVicile GIlly __ tllIV8fB8M __ . ehargo ill atIa.fIl '" ". __ PIllIIdwn 0II/l.Imn below. Eal:h of <br />__ __.. appI'f only to 0- ".tdD8".mwn U GCMnd "._. "AuIAIS" alllllllMl\ as -.d"~ tar. <br />partlculw_raoe by lhe eIItry of _.... _ of the 1Yll.t..lls fnIm the COI/ERED AI11'O 8aatian or 1M ~ AulD <br />Cov8I8gIl Farm IlIIIt to 1M nwne oI11le CIlV8IaIlIL <br /> <br />~.- .lIt <br /> <br />Cll.~_..4 <br />AuIDe <br /> <br />loW <br />,.. ...... w. WI!"'.~' OM <br />Il T' -or~ <br />S 1,000,000 <br /> <br />~....... <br /> <br />IJABl1.ltY <br /> <br />01 <br /> <br />$ <br /> <br />1,381.00 <br /> <br />~ lNJlFIYA<<JI1:\011UN <br />(or -"l'i..1lI8t4 ND-FaIlII--.1 <br />ADOE:1) PERSONAL INJURY <br />PROTE<mON (CII'tqUIva'-'t added <br />No-huII CllVtlIqI) <br />0Pt10NAl. ElASIC ECONOMIC <br />LOSS 'tN.. York only) <br />PROPEFl'TY PROTEC'TlON <br />INSURANCE (MIahigan mly) <br /> <br />~ 6IDd In eaolI "-naI II$IIY <br />P.tI~~ <br /> <br />~ sta1I8d III eaolI Addad PO'SIlnal <br />Injury Plu"""'" El~ <br /> <br />Sl!S.* uctI eII;ibko i11lftd ~, <br /> <br />___&tatIIdIll"~ PnlIIIllIan <br />0Innce E14.........1I. <br /> <br />UNINSURED MOTORISTS <br /> <br />02 . Df II. DmIl MlpBIa\IIy I1I18d llr $ 70.00 <br /> 4lICh "8UtD" in lTBI THREE. <br />02 . $ 130.00 <br /> sa PORk 1lA210.:l OIl. <br /> S'lME PORII(S) <br /> S <br /> <br />AIJJO MEllCAl PAYMENTS <br /> <br />UNaERINSURED MOTORIST'S <br />(Wh8n lIClI inc:lud8d in ~ <br />MotDriIl CDlI1Ir'agIJ) <br /> <br />l'cnI ItA ClO 25 oa III <br /> <br />~hf4 <br /> <br />f:ll :39\Id <br /> <br />l.ZQ I "'111.1.1 :n,un <br /> <br />9S8pEE~619 7.~:AT QQQ7J07'Tn <br />