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)~ SCOTTSDALE INSURANCE COMP~ <br />GARAGE INSURANCE COVERAGE PART SUPPLEMENTAL DECLARATIONS (continued) <br />Policy No.: ______ -'r""r."',s"'9'!.ln'-!4 ... 1w1c.:Q"'O'-----_______ Effective Date: ____ --'.n'-'lu/:...2'-'J..L( ... ?~Q ... l""I\----- <br />(12:01 A.M. Standard Time) <br />Named Insured: fl }I ~N rI ~ It ,C O N ~1IlrTM!IT S I N'l'tl RNA TJ QNIi J, Agent No.: _______ ...:.1u6udluOw:Ii'--_____ _ <br />Item 1. Dealers, Non-Dealers And Trailer Dealers Schedule Of Specifically Described "Autos" <br />Auto Year, Make, Model, Vehicle Identification N urn ber Cost! Value No. . . - <br />Auto Loss Payee -All Physical Damage loss Is <br />No. GVW Use Radius Code payable to you and the loss payee nam ed <br />below according to their Interests In the <br />auto at the time of the loss. <br />COVERAGES (Will apply as indicated by entry of a premium). <br />Lla,bility <br />Specified Causes Com prehensive Collision Medical Personal InJury <br />oJ Loss Payments Protection <br />Auto Premium Dod . Premium Oed. Premium Oed . Premium Premium P fs l11 l u ril No . <br />Total $ XXX $ XXX $ XXX $. . $ ~ <br />Item a.Drive-Away Schedule (Pick-Up and Delivery Liability, DealerDrive-Away Collision) <br />The limit of three hundred (300) miles shown in the Drive-Away exclusions contained in the CHANGES IN THE AUTO DEAL- <br />ERS COVERAGE FORM endorsement is extended by completion of the following: . .,': <br />Extend ed to ______ miles for an additional premium of $ ______ _ <br />Includes copyrighted m ateriat of ISO Properties, Inc., with its perm Isslon. <br />Copyright, ISO Properties, Inc .. 2009 <br />CGS-0434 (10-16) Page 40f4 <br />RECEIVED <br />MAR 2 3 2018 <br />'}(i'!'T,' ,'; ::.> '! ;~; ~:':R1FF <br />-:CC ;~JTrh!,"