HomeMy WebLinkAbout437747 R & D VENDING (ROGER D SORENSEN) - INSURANCE CERTIFICATE*ame
CERTIFICATE OF INSURANCE
T® STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois
❑ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
inng policyholder for the coverages indicated below:
policyholder SORENSEN, ROGER D DBA R&D VENDING
Address of policyholder 2300 SILVER TRAILS COURT
Location of operations
FORT COLLINS, CO 80526-6418
COLORADO
Description of operations
The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is
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POLICY NUMBER
TYPE OF INSURANCE
POLICY PERIOD
Effective Date Ex !radon Date
LIMITS OF LIABILITY
at be inning of policy period)
Comprehensive
BODILY INJURY AND
96-E9-9212-2
Business Liability
10/05/06
10/05/07
PROPERTY DAMAGE
This insurance includes: ® Products - Completed Operations
® Contractual Liability
® Underground Hazard Coverage
Each Occurrence $ 1, 000, 000
® Personal Injury
® Advertising Injury
General Aggregate $ 2, 0 0 0, 0 0 0
❑ Explosion Hazard Coverage
Products - Completed
❑ Collapse Hazard Coverage
Operations Aggregate $ 2 , 0 0 0 , 0 0 0
❑ General Aggregate Limit applies to each project
❑Cl
EXCESS LIABILITY
POLICY PERIOD
BODILY INJURY AND PROPERTY DAMAGE
Effective Date Expiration Date
(Combined Single Limit)
❑ Umbrella
Each Occurrence $
❑ Other
Aggregate $
Part 1 STATUTORY
Part 2 BODILY INJURY
Workers' Compensation
and Employers Liability
Each Accident $
Disease Each Employee $
Disease - Policy Limit $
POLICY NUMBER
TYPE OF INSURANCE
POLICY PERIOD
LIMITS OF LIABILITY
Effective Date Ex im on Date
at beginning of policy period)
96-GO-0240-5
COMM. UMBRELLA
10/0505
10 05 07
$1,000,000
661 7044-BO1
AUTOMOBILE INS
08 O1 95
08/01/07
$1,000,000
IT any or me oescnDea ponies are cancelea Derore its
expiration date, State Farm will try to mail a written notice to
the certificate holder 3 0 days before cancellation. If,
however, we fait to mail such notice, no obligation or liability
will be imposed on State Farm or its agents or
Name and Address of Certificate Holder
PACKAGING CORPORATION OF AMERICA
1201 CORNERSTONE DRIVE Ai e oriel e v
WINDSOR, CO 80550
ATTN: ANN FAX: 970-686-5767 Title _
558-994 a 2.90 Printed in USA oate BRADLEY D. BISCHOFF
State Farm Insurance
1300 Oakridge Drive, Suite 100
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