Loading...
Rural Route 2 .rI/247 PE~~IT T~~BUILDING OR DEMOLISH STRUCTURE !-i1-C)t;., , Fee Paid: $15.00 Date: ~;J.eYVLi..A.-ed J r, / r r c Contractor: Owner: Name: E ct vJ (zr c~ .1)-'-'.( h({ r' if Address: 20 <; tj ~.( cJ s)- IJ 1 Cl ~/ 1 fl) ~ / Name: 0 IUe) n1CV~'fj(1 Ci,J'l'1j1Q\1j j Address: f-o, ~ o-.j. ) J )-2> . Vu '" II j' ~+-cl1 ; It) 0 S' IS ~O J h Joe) f1 The above described person is hereby granted a / permit t(3Mo~r2 ~e.<:... ~~ ~ lfY/S / /~ Qj:emQ:.l=~ building i 0 LJ feet long, and () () G~lhone now located on I\. "" 2.. Ie s.;J-eY1.t, City of Blair, feet high, finally located on (z ~ fZ _ 42- {\. ~Y'i' .::)(i "(V\,\,{-,< It be done on, fOri' 1 Nebraska, to be The ~;)) or I > N qr.;, and shall take (Demolition) is to ~ hours. The route to be taken in the removal thereof is as follows: (Here designate the names and numbers of the streets, alleys, or public grounds to. be 'crossed): 3'c.e c><tf- l.( C h -{U~ 5 h -t:''€- L The removal thereof shall be under the direction of the Street Commissioner and the Director of Public Works. . The building is to be used for \\ 6 LA) ~ YI.J 5 ~ ~ Cl } e F; l'\.)~urposes. A statement that all taxes and special assessments on the building to be moved or demolished and on the land from which it is to be moved or demolished have been fully paid was received ].2- / U/9 'J and is attached. A corporate surety bond or two personal sureties to pay all damages that may be sustained to any property, public or private and including curbs, paving, manholes, public utility lines and pipes, by reason of the moving or demolishing such building was received on and is attached. City Clerk City Administrator The Maguire Agency 1935 West Co Road B-2, #241 P. O. Box 64316 St. Paul, MN 55164-0316 .~]~~r~~;~:~:'8~~;~:fm~~~:~ffi(~~E>'I:~~f.~~fM;)21P~~tU~I~.:ilf~r,1t~.e;f~~~f~.:f~:i#!f&~rtJl~f:{~W~~~liJ~:~1:~f!11J.]~lij~df'TIlli"'I~"O~TE IM~DOI~ w" ... HIm ~~l;;~~~f2~I"OUm'.h\l~o:e.w.-m~......$j....L...."......."....................""..-,. 05/04/95 ;..::::>..:....:. ~: -.:~ :".. ii:::-..:.: ::.... .'. ,/:' -. : , '- . .:.$~w.;:,!Nimu.Wl$.Wf'.#.#.iWt~~W#.J.-t##.{@t.@} THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATI DOES NOT AMEND, EXTEND on ALTEn TUE COVEnAGE AFFonDED IlY Till PO CIES BELOW. IOOUCfJ'l COMPANIES AFFORDING COVERAGE COMPANY A IJm'1i;R St. Paul Companies SAO COMPANY rlt I.IiTtiR Ii) lURED O'Neil Company, Inc. P. O. Box 1113 Williston, ND 58801 COMPANY C I.IiTtiR COMPANY n LiT'TEA uP COMPANY E IJm'1i;R oVE.R~GS.::p~~f$\~("~':-:"-:'" :.:.:., ...., ..._,......::..:. .."".:......:.......""......:.. ........m........ ._,'.' ...... ........... ...'::'...:. :::<;~.~..:......:..,.:......:.,........<..,. ::...~:.., MW:.:-:::.,.-:..:....if.:..:. t:.:.:....:. :':':'W:.:.:;.tfj@Wti';iiW@iiiH:f:::j::. THIS IS TO CERTIFY THAT THE POLIOIES OF INSURANCE LISTED HELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEAIOD INDICATED. NOlW/THSTANDING ANY RECUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMeNT WITH RESPECT TO WHICH ~IS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THe INSURANCE AFFORDED BY THE POliCIES DeSCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. mE 01' INaURANCIII POUCY NUMBER POUCYE~cnVE POUCYEX~RAnON DATIi (MWOOIVV) DATIi (MWDOIVV) UMlTIl GENERAL UAIllUTY COMMERCIAl. GENERAL LIABIUlY CLAIMII MAOEW OCCUR. OWNER'S .. CONTRACTOR'S PRO CK06307830 06/01195 06/01196 GENERAL AGGREGATE S PROOUCTS.cOMPIOP AOO. . PERSONAL" AOV. INJURY S EACH OCCURRENCE FIRE DAMAGe (Any one IlIel MEO, WENSE (Any on. peraon 1,000,000 1,000,000 1,000,000 1,000,000 50,000 5,000 AUTOIoIOIIlUi UAIIlUTY X ANY AUTO Al.l. OWNED AUTOlI SCHEOUUiD AUTOlI X HIRED AUTOS X NON-OWNEO AUTOS GARAGli I.IABIUTY COMBINED SINGLE . LIMIT BOOIL Y INJURY . CK06307830 06/01195 06/01196 (Por ""'100ft) BODILY INJURY . (Pw IIICddem) PROPERTY DAMAGE S 1,000,000 EXCESlI UAIllUTV X CK06307830 06/01195 06/01196 EACH OCCURRENCi AOGREOATIi S S 3,000,000 3,000,000 WORKER" COIoflPENSA nON AHl) EW>LOY&R$' UAalUTY STAl\JTORV Lt.lITS EACH ACCIDENT S OISEASE-POLICY LIMIT a OISEASE-EACH EMPl.OViE a OTHER THAN UMBREllA FORM ~~~1:~~j*r:;~t(~r.~~;m;~~~~~;~~mit~i~t.~ilij~mt~tW~ ornER Carzo Coverage IM06301829 06101195 06/01196 Special Form - $.SOO Ded. $75,000 ADY ODe Item :SCRWTlOH Of< OKAATlOtwL.OCATIOH8NOilCUllaKC&Al.ITiWi . . ;;AiJ~telB '.' ~. . <Q.r.t)'Jl~$t&~y"':" , -fl~~~,~~~';iy.i:' . :. :". : .:~ ': . Q . <' ~ \<: ,'.W;";'){i1S :<<."""'~::t.::?~~~t~~W..w."t.w%<<<~~K~};..""~.f'-%'M>>.?';MI"*~ . " i... ". ),\:. SHOULD ANi OF ruE ABOVE DeSCRIBED POLICIES BE CANCEllED BEFORE THE '. .~'/' .: l . EXPIRATION CATE ruEREOF, ruE ISSUING COMPANY WIlL ENDEAVOR TO .,;,..,./" !i MAli. 1.2- CAVS WRITTEN NOTICE TO THE CERTIFICATE HOlOER tw.'CD TO THE . . .< LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHAll IMPOSE NO OBLIGATION OR '~'; '\ LIABIUTV OF ANY KINO UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES, _, ' ~< AUTHORJU:D R&:J>RUEHTATlVI .,.. f,:"'a/~~0:....rI. ~ ~ : . . "" .~'Y:. ':~W@tBi~~B~Aco.R.P.iC.O:ijJWltAit.lj.'),N::~1:~~ ! , ,1~', . ~". Slale of Montana Gross Vehicle WeIght DivIsIon Departm~nt of Hlihways Box 4639 Helena, MT 59604 . ~ ~ Classic Title Company ... .'C .~:t., File No.: CS01571 Propert)',A4~J:CSS:...lUU Blair, Nebraska 68008 Edward N. Buchardt 507.74.3U8 l'urchaser :SOCial :secunty NO. LuAnn C. Buchardt l'urchaser :SOcial :secunty NO. rurChaser :social :Secunty No. Purchaser :social :secunty No. rurChaser :Social :secunty NO. rurcnaser :SoClal :secunty No. Purchaser's Address: 2054 Front Street, Blair, NE 68008 DEBIT CREDIT Purchase Price $23,500.00 Settlement or Closing Fee to Classic Title Company Abstract Fee to Classic Title Company Deposit Amount Paid By/For Purchaser(s) Total Due From Purchaser(s) Total Due From Purchaser(s) Amount Paid By/For Purchaser(s) Net from Purchaser(s) 100.00 32.50 1,000.00 ----------- ----------- 1,000.00 ----------- ----------- 23,632.50 23,632.50 1,000.00 --------.....-- ----------- 22,632.50 TAXES: - KEY NO. 18-11-26 TL43, 1994 IN THE AMOUNT OF $3,276.56, PAID. 1995 IN THE AMOUNT OF $3,177.54, PAID. TAXES: - KEY NO. 18-11-26 TL44, 1994 IN THE AMOUNT OF $1,010.00, PAID. 1995 IN THE AMOUNT OF $980.00, PAID. SPECIAL ASSESSMENTS: NONE OF RECORD. FOR INFORMATION PURPOSES ONLY: ADDRESS OF SUBJECT PROPERTY ACCORDING TO THE RECORDS OF THE COUNTY TREASURER: RR 2, BLAIR. THIS IS A REPORT OF APPARENT CURRENT RECORD OWNERSHIP AND LIENS ONLY, AND IS NOT INTENDED TO PROVIDE ASSURANCE OF THE VALIDITY OR SUFFICIENCY OF ANY INSTRUMENT OR PROCEEDING IN THE RECORD TITLE, AND NO LIABILITY IS ASSUMED HEREUNDER FOR ANY MATTERS TO WHICH THIS REPORT DOES NOT SPECIFICALLY CERTIFY. THIS REPORT IS INTENDED FOR USE ONLY BY THE PARTY OR PARTIES TO WHOM IT IS ADDRESSED, AND NO OTHER PARTY OR PARTIES ARE ENTITLED TO RELY ON THIS REPORT OR ANY INFORMATION CONTAINED HEREIN. THIS REPORT IS NOT INTENDED FOR USE IN FIRST MORTGAGE LENDING. WITNESS MY HAND THIS 11TH DAY OF DECEMBER, 1995 AT 8:00 A.M. CLASSIC TITLE COMPANY BY: REGISTERED ABSTRACTER rrnrk . ~rab6e.. 1:<5 :<"0 .2.. / a mr5. C!wles ksl,e. Bro we , wjlmd- Wu'~rl1l .fnn.",rdOuJ7l .:rr. 2(, ,[;ayid P. Q::\i~e Lo.rrj." ~ 776 . . Ya.r~r S/a.J Y rna..rvm Nielsen OJ+ Jesser! JOhn . 13ren+ ~ fknJoo o.r.p :JO~ . ~;7 · nd :l..8fu ~ /...ela. ole Yoqf- OlscTl · "" I tJ. · ; ;-os!- - uJes iLonS ,:t-h 'ens -:-;r .J# c ~ L4)e - .. r1'irs b IV Qhrisl-ensen o KevIY] ,Kuhle.. 17 o ~rd (sor7 .7?/C!hard Mfma. Yl ~ (!,.f,ffCrc1 " Hansen Lid reQsc~ Duane . Vc:r Q o e t..Jre71 rfc:fYJ 3Jrqe. ... "ro~ lU""~Y)' !-Iu17~ 3:2. eukn Scrl .. () mrs"ferry arde~n . -~ - -_.- I:il L'jmcn .. W(l9!r1-son \ Q . B. ::rOil) u.L\t..'e Fuhlr . LJpp'n('L'r. _'c.' I.v. Scrensen ~rren 1'"u hired!- ~r r~T7 5cnny Un/ell . /!lD-rK. ?ersSo Ii . . Fred Bloemer C) /, 4n(l.ld . {Lndersell <!fur 16 _ Gleesz, n '~ w (Ich . )0 f'Tl 5e.e+ton ,1&> J- :rerry 8reemrs !) - Fra.nK KDnfrst 3_ nOCfU 7Iuq'le.. L/ _ Fred i!a.rriiJ.- 5_ e/yde. Frerdl. I:- -I?eberr if. Hansen '1_ fuY'e. 'ore'Z. ~ - 'Rc.sa... s+ere '?<'CI(. :x: h 11 'm,"/Ier \) 33 rrD 6erf . rrns1e r S Elmer -mct?e,J'r, 3</ Chules _ . St:serrt3.'Yl)? -c 'J:; rn I \lt/~ s: o Q \-\c y\- Sf-encier ~JeYl .an:JerSon . RE<:.- /? De SOTA -I 0::- Z ! 7J CD r- J> - :u '"d l>> Otl CIl Vl ~ ~ Fidelity and Deposit Company of Maryland Home Office: P.O. Box 1227, Baltimore, 11]) 21203-1227 NOTICE OF CANCELLATION March 6, 1998 City of Blair 218 South 16th Street Blair, NE 68008 The undersigned Surety upon a certain LicenselPermit Bond in your favor as follows: Principal: O'Neil Company, Inc., P.O. Box 1113, Williston, ND 58801 Bond No.: 30443790 Amount of Coverage: $1,000 Effective Date: 05/0393 hereby notifies you that it desires to cancel and does hereby cancel said bond as an entirety. Such cancellation to become effective 05/03/98. Please send written confirmation of this notice to the address below. This notice is given to you in accordance with the cancellation provision in said bond contained. By: Deanna Freeman, Attorney-in-Fact Fidelity & Deposit Co. of Maryland Central Regional Surety Office 9401 Indian Creek Parkway, Ste. 800 Overland Park, KS 66210 ORIGINAL TO OBLIGEE PRINCIPAL'S COPY AGENT'S COpy RO. FILE ROOM COPY BRANCH OmCE COpy J310 License and Ohio Farmers Insurance Co. Permit Bond Westfield Companies Westfield Center, Ohio 44251-5001 KNOW ALL MEN BY THESE PRESENTS: BOND No5668134 Thatwe, O'Neil Company, Inc. PO Box 1113 Williston ND 58801 of the City of Williston , State of North Dakota , as Principal, and the OH10 FARMERS INSURANCE COMPANY, a corporation organized and existing under the laws of the State of Ohio and duly licensed to do business in the State of Nebraslr.d as Surety, are held and firmly bound unto the City of Blair 218 S . 16th St . of Blair , State of NE 68008 , Obligee, in the penal sum of One thousand and 00/ 100**********xx**r****** (*1 , 000.00T*T) DOLLARS, (NOT VALID IF FILLED IN FOR MORE THAN $10,000.00) lawful money of the United States, to be paid to the said Obligee, for which payment well and truly to be made, we bind ourselves and our legal representatives, jointly and severally by these presents. THE CONDITION OF THE ABOVE OBLIGATION IS SUCH, That whereas, commencing on the 3rd day of May , 1998 the said Principal has been granted a permit for I licensed as ❑ Housemovers Bond by the said Obligee. NOW THEREFORE, if the said Principal shall faithfully perform the duties and in all things comply with the laws and ordinances, including all Amendments thereto, appertaining to the license or permit applied for, then this obligation to be void, otherwise to remain in full force and effect until May 3rd 19 99 , unless renewed by Continuation Certificate. This bond may be terminated at any time by the Surety upon sending notice in writing, by certified mail, to the clerk of the Political Subdivision with whom this bond is filed and to the Principal, addressed to them at the Political Subdivision named herein, and at the expiration of thirty (30) days from the mailing of said notice, this bond shall ipso facto terminate and the Surety shall thereupon be relieved from any liability for any acts or omissions of the Principal subsequent to said date. Dated this 23rd day of February , 19 98 Countersigning Agent: Robert Lee Reynoldson UNICO, Group Inc. 4435 "o" St. Lincoln NE 68510 Robert Lee Reynoldson O'Neil Comnanv, Inc. Principal Principal OHIO FARMERS INSURANCE COMPANY By Michae J . agui A.ttornev In Fact General Power of Attorney CERTIFIED COPY POWER NO. 4058561 00 Insurance Co. Westfield Center, Ohio Know All Men by These Presents, That OHIO FARMERS INSURANCE COMPANY, a corporation duly organized and existing under the laws of the State of Ohio, and having its principal office in Westfield Center, Medina County, Ohio, does by these presents make, constitute and appoint MICHAEL J. MAGUIRE, KATHERINE A. MAGUIRE, DANIEL MAGUIRE, JOINTLY OR SEVERALLY of RAPID CITY and State of SD Its true and lawful Attorney(s)-in-Fact, with full power and authority hereby conferred In Its name, place and stead, to execute, acknowledge and deliver any and all bonds, undertakings, and recognizances; provided, however, that the penal sum of any one such Instrument executed hereunder shall not exceed ONE MILLION DOLLARS AND NO CENTS ($1,000,000)---- LIMITATION: THIS POWER OF ATTORNEY CANNOT BE USED TO EXECUTE NOTE GUARANTEE, MORTGAGE DEFICIENCY, MORTGAGE GUIRAIFITREE, OR BANK DEPOSITORY BONDS. and to bind the Company thereby as fully and to the same extent as If such bonds were signed by the President, sealed with the corporate seal of the Company and duly attested by Its Secretary, hereby ratifying and confirming all that the said Attorney(s)-in-Fact may do in the premises. Said appointment is made under and by authority of the following resolutions adopted by the Board of Directors of the Ohio Farmers Insurance Company: "Be It Resolved, that the President, any Vice -President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorneys) -in -Fact to represent and act for and on behalf of the Company subject to the following provisions: "Section 1. Attorney -in -Fact. Attorney -In -Fact may be given full power and authority for and In the name of and on behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements of indemnity and other conditional or obligatory undertakings and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such Instruments so executed by any such Attorney -in -Fact shall be as binding upon the Company as if signed by the President and sealed and attested by the Corporate Secretary." (Adopted at a meeting held on the 3rd day of July, 1957.) "Be It Resolved, that the power and authority to appoint Attorneys) -In -Fact granted to certain officers by a resolution of this Board on the 3rd day of July, 1957, is hereby also granted to any Assistant Vice -President." (Adopted at a meeting held on the 13th day of July, 1976.) This power of attorney and certificate Is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Ohio Farmers Insurance Company at a meeting duly called and held on the 9th day of June, 1970: "Be It Resolved, that the signature of any authorized officer and the seal of the Company hertofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signatures or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which It is attached." In Witness Whereof, OHIO FARMERS INSURANCE COMPANY has caused these presents to be signed by Its Vice President, and Its corporate seal to be hereto affixed this 05th day of MAY A.D., 1993 . Corporate �p,1./1•r,,,,,�OHIO FARMERS INSURANCE COMPANY Seal Affixed . °.° .D'• a $�i i s 184 A By State of Ohio `�y °•°°• °°�'��Gerald G. Stahl Vice President County of Medina ss.: ��0�•a„i„uua° °.° On this 05th day of MAY A.D., 1993 , before me personally came Gerald G. Stahl, to me known, who, being by me duly sworn, did depose and say, that he resides in Westfield Center, Ohio; that he Is Vice President of OHIO FARMERS INSURANCE COMPANY, the company described in and which executed the above Instrument; that he knows the seal of said Company; that the seal affixed to said Instrument is such corporate seal; that It was so affixed by order of the Board of Directors of said Company; and that he signed his name thereto by like order. Notarial w•,wwi�ea Seal µ1 A L S Affixed /Cp James M. Walker Notary Public State of Ohio 10 o County of Medina ss.: \, qr o N My Commission Does Not Expire Sec. 147.03 Ohio Revised Code '1j1111111111111•• CERTIFICATE 1, Richard L. Kinnaird, Jr., Assistant Secretary of the OHIO FARMERS INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Company, which Is still in full force and effect; and furthermore, the resolutions of the Board of Directors, set out in the Power of Attorney are in full force and effect. L In Witness Whereof, I hav heraunto set my hand and affixed the seal of said Company at Westfield Center, Ohio, this 03—\ day of A.D., \el,i`"nuou, 184a ` .• Richard L. Kinnaird, Jr. Assistant Secretary BPOAO1 (07-95) ACORDCERTIFICATE OF LIABILITY INSURANCkow RC DATE(MM/DDIYY) PRO-1 04/26/99 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE The Maguire Agency 1935 West County Road B-2 , #241 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Roseville MN 55113 COMPANIES AFFORDING COVERAGE Matthew A. Sundeen Pl,oneNo. 651-638-9100 Fax No.651-638-9762 COMPANY A Federal Insurance Company INSURED COMPANY B COMPANY Morrow's, Inc. C P, O. BOX 64 Jackson NE 68743 COMPANY D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDD/YY) POLICY EXPIRATION DATE (MMIDDIYY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $500,000 A X COMMERCIAL GENERAL LIABILITY 79395896 06/01/99 06/01/00 PRODUCTS - COMPIOPAGG $500,000 CLAIMS MADE ❑X OCCUR PERSONAL & ADV INJURY $500,000 EACH OCCURRENCE $ 500,000 OWNER'S & CONTRACTOR'S PROT FIRE DAMAGE (Any one fire) $ 50,000 MED EXP (Any one person) $ 5,000 A AUTOMOBILE LIABILITY ANY AUTO 79395897 06/01/99 06/01/00 COMBINED SINGLE LIMIT $ 1,000,000 X BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS X PROPERTY DAMAGE $ 11 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: ANY AUTO EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ UMBRELLA FORM $ OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY TO OTH- RY LLIMIIMITS ER EL EACH ACCIDENT $ EL DISEASE - POLICY LIMIT $ THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE EL DISEASE - EA EMPLOYEE $ OFFICERS ARE: EXCL OTHER A Cargo Coverage 79395896 06/01/99 06/01/00 ACV up to $100,000 $1000 Ded: DESCRIPTION OF OPERATIONS/LOCATIONSA/EHICLESISPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION XBLAIRZ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL City of Blair 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Attn r Brenda Taylor 218 South 16th Street BUT FAILURE TO MAIL SUCH NOTIC SHALL IMPOSE NO OBLIGATION OR LIABILITY Blair, NE 68008 OF ANY KIND UPON THE COMPANY, t S AGENTS OR R RESE IVES. AUTHORIZED REPRESENTATIVE Matthew A. Sundeen ® q ACORD 25-S (1/95) A RD