HomeMy WebLinkAboutCANNON SUSIE KORTH LAUNIE - INSURANCE CERTIFICATEEFFECTIVE DATE: 12:01 AM Standard Time,
(at your principal place of business)
BUSINESSOWNERS
PB Al 07 (01-01)
ACKNOWLEDGEMENT OF ADDITIONAL INSURED STATUS
STATE OR POLITICAL SUBDIVISIONS - PERMITS
RELATING TO PREMISES
Person or Organization Designated as an Additional Insured:
CITY OF FT. COLLINS,ATTN: JOHN STEPHEN
P.O. BOX 580, FT. COLLINS, CO 80521
Designated Premises:
223 SOUTH HOWES STREET
FORT COLLINS CO 805210000
This form has been sent to you to acknowledge your status as an additional insured under our, meaning the is-
suing Company stated below, insurance policy issued to the Named Insured shown below.
Under our Premier Businessowners Liability Coverage Form, Section II. WHO IS AN INSURED provides as fol-
lows:
Any of the following persons or organizations are automatically insureds when you [i.e. the Named Insured
stated below] and such person or organization have agreed in a written contract or agreement that such
person or organization be added as an additional insured on your policy providing general liability coverage.
State or Political Subdivisions - Permits Relatina to Premises
Any state or political subdivision which has issued a permit in connection with premises insured by this
Policy which you own, rent, or control is an additional insured, but only with respect to the following hazards:
1) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings,
canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk
vaults, street banners, or decoration and similar exposures;
2) The construction, erection, or removal of elevators; or
3) The ownership, maintenance, or use of any elevators covered by this insurance.
HOWEVER, such state or political subdivision's status as additional insured under this policy ends when the
permit ends.
The policy language set forth above is subject to all of the terms and conditions of the policy issued to the Named
Insured shown below. For your information, our Named Insured, the Policy Number, Policy Term and Limits of
Insurance are stated below.
Named Insured CANNON, SUSIE; KORTH, LAUNIE - AS A PARTNERSHIP ENTITY ONLY - DBA
Issuing Company: AMCO INSURANCE COMPANY
Policy Number: ACP BPS 7570068542
Policy Term: 10-15-04 To 10-15-05
Limits of Insurance: Per Occurrence $1,000,000
All Occurrences $2,000,000
PB Al 07 (01-01)
ACP BPS 7570068542 ADDL INSRD COPY
75 39400