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C O V E R N O T E (Form N o. TD-68-a) . ? U 1 Cove mu&Mci mm&kMim 4151 10/1 2 /5 0 Insured Inception D ate Address. E xpiration D ate . C O V E R N O T E Cover N ote N o . X 4151 Pacific Employers Insurance Company H o m e O ffic e: Los Angeles 15 through E M E T T and C H A N D L E R — 6 1 0 So. Broadw ay, Los Angeles 14 Pacific Employers Insurance Company hereby acknowledges itself bound to the insured named and described herein by insurance as provided in this cover note for the kinds of insurance as indicated hereunder, with respect only to operations as a contractor for Union Pacific Railroad Company, and/or its affiliated companies, and subject to the terms, conditions, exclusions, limitations, general agreements and warranties of the applicable printed policy forms used by the Company at the time of inception hereof. Name of Insured- P. O. Address____ Plii imsm ma m itissiJMi B m p t in p tj, Legal Description of Insured. Location and Description of Such W ork_ (Individual, Co-partnership or Corporation) K I N D O F IN S U R A N C E L IM IT S O F L I A B I L I T Y EACH PERSON EACH OCCURRENCE EACH ACCIDENT AGGREGATE W orkm en’s Compensation ------------------ .--- —---------- 1 Employer’s Liability » a s s i f 1 N o t Applicable f N o t Applicable N o t Applicable m r w M g u M i N o t Applicable P N o t Applicable Bodily Injury L i a b i l i t y O t h e r than Autom obile, Products and Contractual $ 2 5 ,0 0 0 $ 1 0 0 ,0 0 0 N o t Applicable N o t Applicable Property Damage Liability — Other than Autom obile, Products and Contractual N o t Applicable N o t Applicable $ 2 5 ,0 0 0 $ 1 0 0 ,0 0 0 Contractor’s Contractual Bodily Injury Liability $ 2 5 ,0 0 0 $ 5 0 ,0 0 0 N o t Applicable N o t Applicable Contractor’s Contractual Property Damage Liability N o t Applicable N o t Applicable $ 2 5 ,0 0 0 $ 2 5 ,0 0 0 This cover note period commences on the_ -day o f_ OG&teme _, 19^ ’^ __, at i j l L i M , and ends on th e J L 2 J a l_ day of_ 19. 30 ., at 12:01 a.m., standard time, at the place where this cover note has been countersigned. The policy or policies o f insurance w ill be forwarded to you in due course and w ill supersede this cover note. Countersigned at Secretary President -this— %MMi -day o f_ I N H W ' _, 19. Agent: Emett and Chandler Form TD-68-a 500 6-50 B y- This Cover Note Void Unless Countersigned by a Duly Authorized Representative