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Home My WebLink About437747 R & D VENDING (ROGER D SORENSEN) - INSURANCE CERTIFICATE (2)CERTIFICATE OF INSURANCE This certifies that ® STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois ❑ STATE FARM GENERAL INSURANCE COMPANY Bloomington Illinois insures the following policyholder for the coverages indicated below, Name of policyholder SORENSEN, ROGER D DBA R&D VENDING Address of policyholder Location of operations 2300 SILVER TRAILS COURT FORT COLLINS. CO 80526-6418 • • f 1-9 • 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 subiect to all the terms esrJusinnsand cnnddions nt thnse onhcies Thin limits of liability shown may have heen reduced by anv paid claims POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY Effective Date Expiration Date at beginning of policy period Comprehensive BODILY INJURY AND 96-E9-9212-2 Business Liability 10/OS/07 10/OS/OS PROPERTY DAMAGE I Thls insurance includes ® Products - Completed Operations ® Contractual Liability ® Underground Hazard Coverage Each Occurrence $ 1, 000 , 000 ® Personal Injury ® Advertising injury General Aggregate $2,000,000 ❑ Explosion Hazard Coverage Products - Completed ❑ Collapse Hazard Coverage Operations Aggregate $ 2 , 000 , 000 ❑ General Aggregate Limit applies to each protect POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE EXCESS LIABILITY Effective Date Expiration Date (Combined Single Limit) ❑ Umbrella Each Occurrence $ ❑ Other Aggregate $ Part t 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 Expiration Date at beginning of policy period) 96-GO-0240-5 COMM UMBRELLA 10 05/07 10/0508 $1,000,000 661 7044-NO AUTOMOBILE INS OB/Ol 95 08/01 OS $I 000,000 Name and Address of Certificate Holder THE CITY OF FORT COLLINS 215 N MASON FORT COLLINS, COLORADO ATTN DAVID CAREY FAX #221-6707 8OS24 BRADLEY D BISCHOFF State Fa,m Insurance 1300 Oakridge Drive, Suite 100 rtrt CoNins, Colorado 80525 (970)223-9400 if any of the described policies are canceea oetore ns expiration date, State Farm will try to mall a written notice to the certificate holder 30 days before cancellation If, however, we fad to mad such notice, no obligation or liability will be imposed on State Farm or its agents or t d dZ0 Z 6 LO 6Z 100 I TATC %ARM :saaa ATE FARM INSURANCE COMPANIES Bradley D. Bischoff Agency 1300 Oakridge Drive, Suite 100 Fort Collins, CO 80525 (970) 223-9400 Fax (970) 223-3393 Toll Free 888-229-5558 EmailAddress mww bradbrschoff com TOTAL PAGES BEING SENT INCLUDING COVER SHEET TO- THE CITY OF FORT COLLINS AT'TN DAVID CAREY FAX: 221-6707 DATE: OCTOBER 29, 2007 TIME: 3:00 P M —2 FROM: Kelly Schlager, LSA5 EMAIL kell,rabradbischoff.com REFERENCE: ATTACHED ADDITIONAL INSURED ENDORSEMENT FOR ROGER SORENSEN DBA R&D VENDING Dear Davui, As per our conversation of this morning, please see attached the Additional Insured Endorsement that you needed for my insured, Roger Sorensen DBA R&D Vending. Please let me know if you need any additional information. Regards, A4 Kelly Schlager, LSA5 Bradley D. Bischoff Agency STATE FARM INSURANCE COMPANIES Canfidemiality NOaaa Thu fa untie cuntaou mfor uon beloo� w the scodv, wtueh is eanfdcnaal and legally pnAeged. Tha Lnronoea is sowdy for the use of the ami vidual oreoaty to whom n is addressed as mdianed above IIyou have rceched the tr msmissran m raror, please can ra arrange for ns its m Thank yau. 6 d dq� LO LO 6Z 100 No Text 10/29/2007 14-57 9703301488 STATE FARM FIRE PAGE 02 DDP Policy No 96-E9-9212-2 EFF DATE OCT 29 2007 150E-F913 FEfi606 SECTION II ADDITIONAL INSURED ENDORSEMENT Polley No: 96-E9-9212-2 Named Insured: SORENSEN, ROGER D D8A R & D VENDING Additional Insured (include address): THE CITY OF FORT COLLINS 215 N MASON FORT COLLINS CO 80524 WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED, is amended to include as an insured the Additional Insured shown above, but only to the extent that liability is imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a suit brought for damages for which you are provided coverage The Primary Insurance coverage below applies only when there is an 90 in the box. O Primary Insurance The insurance provided to the Additional Insured shown above shall be pnmary Insurance. Any insurance carned by the Additional Insured shall be nonoontnbutory with respect to coverage provided to you All other policy provisions apply FE-6609 Pdrned In V.S. Zd d9l, 1,0 LO 6Z 100